Basic Information
Provider Information
NPI: 1558833863
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBERTS
FirstName: RACHELE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1501 S POTOMAC ST
Address2:  
City: AURORA
State: CO
PostalCode: 800125411
CountryCode: US
TelephoneNumber: 3036952600
FaxNumber:  
Practice Location
Address1: 1501 S POTOMAC ST
Address2:  
City: AURORA
State: CO
PostalCode: 800125411
CountryCode: US
TelephoneNumber: 3033387111
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/27/2018
LastUpdateDate: 01/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XAPN.0994406-NPCOY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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