Provider Demographics
NPI:1528817780
Name:THRIVE ASPEN LLC
Entity type:Organization
Organization Name:THRIVE ASPEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-C
Authorized Official - Phone:970-618-8796
Mailing Address - Street 1:249 KODIAK DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8140
Mailing Address - Country:US
Mailing Address - Phone:970-618-8796
Mailing Address - Fax:970-645-3168
Practice Address - Street 1:249 KODIAK DR UNIT 201
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8140
Practice Address - Country:US
Practice Address - Phone:970-618-8796
Practice Address - Fax:970-645-3168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE ASPEN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-17
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346754249OtherNPPES