Healthcare Provider Details

I. General information

NPI: 1700510377
Provider Name (Legal Business Name): STEPHANE COSBY RAINSONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 E 104TH AVE UNIT A
THORNTON CO
80233-6136
US

IV. Provider business mailing address

1117 CENTENNIAL RD
FORT COLLINS CO
80525-2353
US

V. Phone/Fax

Practice location:
  • Phone: 303-254-8500
  • Fax: 303-453-4994
Mailing address:
  • Phone: 760-567-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0007436
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: