Provider Demographics
NPI:1568293330
Name:CREAVEN, NOAH (PMHNP)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:CREAVEN
Suffix:
Gender:X
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 N SHIELDS ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1019
Mailing Address - Country:US
Mailing Address - Phone:720-841-0441
Mailing Address - Fax:
Practice Address - Street 1:1502 N SHIELDS ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1019
Practice Address - Country:US
Practice Address - Phone:720-841-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN1000022NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health