1760170880 NPI number — ANNA ELIN SCHALLER PMHNP-BC, APN, RN

Table of content: ANNA ELIN SCHALLER PMHNP-BC, APN, RN (NPI 1760170880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760170880 NPI number — ANNA ELIN SCHALLER PMHNP-BC, APN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHALLER
Provider First Name:
ANNA
Provider Middle Name:
ELIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC, APN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760170880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 W DRY CREEK CIR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80120-4457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-500-5177
Provider Business Mailing Address Fax Number:
720-222-5729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 W DRY CREEK CIR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80120-4457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-500-5177
Provider Business Practice Location Address Fax Number:
720-222-5729
Provider Enumeration Date:
04/26/2023

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: 163W00000X , with the licence number:  RN.1635478 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: APN.0999577-NP , 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)