Provider Demographics
NPI:1831187137
Name:NADKARNI-SIMMONS, DEBORAH (PA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:NADKARNI-SIMMONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 PLAZA CT N
Mailing Address - Street 2:#1A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3531
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:303-604-6243
Practice Address - Street 1:2000 W SOUTH BOULDER RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-1389
Practice Address - Country:US
Practice Address - Phone:303-665-9310
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37221876Medicaid
CO37221876Medicaid
P36550Medicare UPIN