Individual
DR. MIKAELA ROSE FENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1307 E. 7TH AVENUE, PUEBLO, CO 81001
(719) 543-8711
(719) 543-0171
Mailing address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8711
(719) 543-0171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0073570
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2021
Last updated
07/23/2024
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