Provider Demographics
NPI:1720587421
Name:AYZE, ANNIE
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:AYZE
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:PO BOX 271690
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5035
Mailing Address - Country:US
Mailing Address - Phone:720-837-2348
Mailing Address - Fax:
Practice Address - Street 1:2844 E MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-7628
Practice Address - Country:US
Practice Address - Phone:720-837-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician