1538929336 NPI number — RACHAEL LYNN STARK DO

Table of content: RACHAEL LYNN STARK DO (NPI 1538929336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538929336 NPI number — RACHAEL LYNN STARK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STARK
Provider First Name:
RACHAEL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FULLER
Provider Other First Name:
RACHAEL
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538929336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10099 RIDGEGATE PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-5532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-225-4466
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10099 RIDGEGATE PKWY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-225-4466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)