Provider Demographics
NPI:1104160589
Name:TRAVER, STEPHANIE RAE (WHNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:TRAVER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:2449 AZALEA WAY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7929
Mailing Address - Country:US
Mailing Address - Phone:720-581-1732
Mailing Address - Fax:
Practice Address - Street 1:4745 ARAPAHOE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1082
Practice Address - Country:US
Practice Address - Phone:303-441-0587
Practice Address - Fax:303-996-0801
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTRA1-0437-3459363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health