Provider Demographics
NPI:1548690720
Name:MACIAS, ANASTACIA (RN)
Entity type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 E 128TH WAY
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2355
Mailing Address - Country:US
Mailing Address - Phone:720-985-3974
Mailing Address - Fax:
Practice Address - Street 1:5270 E 128TH WAY
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2355
Practice Address - Country:US
Practice Address - Phone:720-985-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0185848163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse