Basic Information
| Provider Information | |||||||||
| NPI: | 1467483321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALADE | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1683 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805507921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706744992 | ||||||||
| FaxNumber: | 9706860845 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 16TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806315114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703502454 | ||||||||
| FaxNumber: | 9703502447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2092 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 67382878 | 05 | CO | MEDICAID | P00287532 | 01 | CO | RAILROAD MEDICARE | OTHER |