Healthcare Provider Details

I. General information

NPI: 1861895807
Provider Name (Legal Business Name): TERESA TANABE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2014
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5996 E 64TH AVE
COMMERCE CITY CO
80022-3317
US

IV. Provider business mailing address

PO BOX 746081
ATLANTA GA
30374-6081
US

V. Phone/Fax

Practice location:
  • Phone: 720-463-6758
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax: 303-996-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number991480
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0991480-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95000952
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0991480-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: