Provider Demographics
NPI:1396244836
Name:QUON, TRISHA (PA-C)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:QUON
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 1:2130 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4504
Mailing Address - Country:US
Mailing Address - Phone:402-350-1674
Mailing Address - Fax:
Practice Address - Street 1:4743 ARAPAHOE AVE STE 102
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1123
Practice Address - Country:US
Practice Address - Phone:303-449-3642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant