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General NPI Number Information
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NPI Number | 1700510377
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Entity Type | Individual
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Provider Name | STEPHANE COSBY RAINSONG PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 3655 E 104TH AVE UNIT A
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City | THORNTON
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State | CO
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Zip | 80233-6136
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Country | US
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Telephone | 303-254-8500
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Fax | 303-453-4994
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Provider Business Mailing Address
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Address Line | 1117 CENTENNIAL RD
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City | FORT COLLINS
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State | CO
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Zip | 80525-2353
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Country | US
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Telephone | 760-567-8793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0007436
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License Number State | CO
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