Provider Demographics
NPI:1962729509
Name:DAW, ROBERTA RUTH (BSN, RN, PTA)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:RUTH
Last Name:DAW
Suffix:
Gender:F
Credentials:BSN, RN, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13302 E JEWELL AVE
Mailing Address - Street 2:204
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5462
Mailing Address - Country:US
Mailing Address - Phone:720-219-3535
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO183955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse