Provider Demographics
NPI:1366775231
Name:REZA, MADONNA BREE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MADONNA
Middle Name:BREE
Last Name:REZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY
Mailing Address - Street 2:STE 370
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-659-7161
Mailing Address - Fax:303-659-8017
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY
Practice Address - Street 2:STE 370
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-659-7161
Practice Address - Fax:303-659-8017
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPAL2851363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant