Provider Demographics
NPI:1174343339
Name:RADEMAKER, ANNA (IBCLC, LMT, CD, CE)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RADEMAKER
Suffix:
Gender:F
Credentials:IBCLC, LMT, CD, CE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 VRAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2250
Mailing Address - Country:US
Mailing Address - Phone:720-910-4912
Mailing Address - Fax:
Practice Address - Street 1:4901 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2025
Practice Address - Country:US
Practice Address - Phone:720-910-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO312038174N00000X
CO0026927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN