Healthcare Provider Details

I. General information

NPI: 1336399609
Provider Name (Legal Business Name): TRAVIS LANE MCNABB REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S BELLAIRE ST APT 405
DENVER CO
80246-7733
US

IV. Provider business mailing address

1230 S BELLAIRE ST APT 405
DENVER CO
80246-7733
US

V. Phone/Fax

Practice location:
  • Phone: 720-519-0067
  • Fax:
Mailing address:
  • Phone: 720-519-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number021859
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number187448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: