MEDICARE: MISS RIDVAN TASSEW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1548985062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RIDVAN TASSEW

Provider Business Mailing Address
First Line	:	7995 EAST MISSISSIPPI AVENUE APP J6
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-2042
Country	:	US
Telephone Number	:	720-641-5618
Fax Number	:

Provider Business Practice Location Address
First Line	:	7995 EAST MISSISSIPPI AVENUE APP J6
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-2042
Country	:	US
Telephone Number	:	720-641-5618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	05/12/2023

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Directions to “ MISS RIDVAN TASSEW ” Practice Location

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