Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-88446
CO
363L00000X
Nurse Practitioner
NP-1596
CO
363LF0000X
Family Nurse Practitioner
Primary
NP-1596
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46622837
—
CO
01
—
P00944852
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
—
Last updated
—
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