Provider Demographics
NPI:1386900017
Name:TRAVER, MICHELLE G (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:G
Last Name:TRAVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAX DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9508
Mailing Address - Country:US
Mailing Address - Phone:303-649-3350
Mailing Address - Fax:303-649-3351
Practice Address - Street 1:250 MAX DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9508
Practice Address - Country:US
Practice Address - Phone:303-649-3350
Practice Address - Fax:303-649-3351
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO3378363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical