Provider Demographics
NPI:1104592633
Name:TADENA, ANA MARIE A
Entity type:Individual
Prefix:
First Name:ANA MARIE
Middle Name:A
Last Name:TADENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 ELKTON DR
Mailing Address - Street 2:
Mailing Address - City:COLO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3539
Mailing Address - Country:US
Mailing Address - Phone:719-599-8999
Mailing Address - Fax:800-806-1413
Practice Address - Street 1:1041 ELKTON DR
Practice Address - Street 2:
Practice Address - City:COLO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3539
Practice Address - Country:US
Practice Address - Phone:719-599-8999
Practice Address - Fax:800-806-1413
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherN/A