Provider Demographics
NPI:1336399609
Name:MCNABB, TRAVIS LANE (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:LANE
Last Name:MCNABB
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S BELLAIRE ST APT 405
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-7733
Mailing Address - Country:US
Mailing Address - Phone:720-519-0067
Mailing Address - Fax:
Practice Address - Street 1:1230 S BELLAIRE ST APT 405
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-7733
Practice Address - Country:US
Practice Address - Phone:720-519-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO021859146L00000X
CO187448163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic