Basic Information
| Provider Information | |||||||||
| NPI: | 1922462654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUMBLES | ||||||||
| FirstName: | CAROLINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8950 E. LOWRY BLVD | ||||||||
| Address2: | INNOVAGE LOWRY ATTN: GAYLE WASHINGTON | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038694664 | ||||||||
| FaxNumber: | 3039961600 | ||||||||
| Practice Location | |||||||||
| Address1: | 3551 CHAMBERS RD STE A-D | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800111330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033750649 | ||||||||
| FaxNumber: | 3033750986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2016 | ||||||||
| LastUpdateDate: | 01/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | APN.0991721-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | CO | MEDICAID |