Basic Information
Provider Information
NPI: 1497882286
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUONANNO
FirstName: ALBERT
MiddleName: ANTHONY
NamePrefix: MR.
NameSuffix: III
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 307 SUN WAY
Address2:  
City: BAILEY
State: CO
PostalCode: 804212154
CountryCode: US
TelephoneNumber: 3038754201
FaxNumber:  
Practice Location
Address1: 2785 S PIERCE ST
Address2:  
City: DENVER
State: CO
PostalCode: 802273531
CountryCode: US
TelephoneNumber: 3039871681
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/27/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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