Provider Demographics
NPI:1780932186
Name:PAVER, VIRGINIA (APN)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:PAVER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:PEAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:4190 E WOODMEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-8075
Mailing Address - Country:US
Mailing Address - Phone:541-979-8405
Mailing Address - Fax:
Practice Address - Street 1:4150 E WOODMEN RD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8042
Practice Address - Country:US
Practice Address - Phone:197-632-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018675363LF0000X
COAPN.0995443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily