Healthcare Provider Details

I. General information

NPI: 1467636787
Provider Name (Legal Business Name): RENAE TABIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENAE MUELLER

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12257 S WADSWORTH BLVD
LITTLETON CO
80125-8504
US

IV. Provider business mailing address

300 S NEVADA AVE
MONTROSE CO
81401-4273
US

V. Phone/Fax

Practice location:
  • Phone: 303-977-4676
  • Fax: 303-583-9035
Mailing address:
  • Phone: 970-249-7751
  • Fax: 970-249-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10005322
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0002974
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: