Healthcare Provider Details

I. General information

NPI: 1104102003
Provider Name (Legal Business Name): TRICIA LEA VATH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 BRYANT ST STE 350
WESTMINSTER CO
80031-3845
US

IV. Provider business mailing address

PO BOX 350370
WESTMINSTER CO
80035-0370
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-2640
  • Fax: 303-430-2625
Mailing address:
  • Phone:
  • Fax: 720-294-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP 990077
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: