MEDICARE: DEBRA DENNIS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	650	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134341209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA DENNIS PA-C

Provider Business Mailing Address
First Line	:	3744 S TIMBERLINE RD
Second Line	:	SUITE 102
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4334
Country	:	US
Telephone Number	:	970-495-0506
Fax Number	:	970-495-0485

Provider Business Practice Location Address
First Line	:	3744 S TIMBERLINE RD
Second Line	:	SUITE 102
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4334
Country	:	US
Telephone Number	:	970-495-0506
Fax Number	:	970-495-0485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	05/07/2014

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Directions to “ DEBRA DENNIS PA-C” Practice Location

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