Provider Demographics
NPI:1750134482
Name:DZRAMEDO TEAGBO, TETE
Entity type:Individual
Prefix:
First Name:TETE
Middle Name:
Last Name:DZRAMEDO TEAGBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25084 E BYERS DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-4659
Mailing Address - Country:US
Mailing Address - Phone:720-427-9447
Mailing Address - Fax:
Practice Address - Street 1:8181 E TUFTS AVE STE 560
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2559
Practice Address - Country:US
Practice Address - Phone:720-669-3480
Practice Address - Fax:720-669-3480
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999665363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care