Individual
KATJE MARIE LEREW MUSGRAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4650 SIGNAL TREE DR UNIT B200, TIMNATH, CO 80547-4911
(970) 821-3830
Mailing address
500 WESTOVER DR # 16969, SANFORD, NC 27330-8941
(505) 470-7498
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101018928
MI
207Q00000X
Family Medicine Physician
A-1644-11
NM
207Q00000X
Family Medicine Physician
Primary
DR0053047
CO
207Q00000X
Family Medicine Physician
T0753
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432680799
—
ME
05
—
44931549
—
CO
01
—
NMAAA2425
MEDICARE ID
CO
01
—
NONE
RESIDENT-NO PROV #
ME
Enumeration date
07/23/2007
Last updated
11/04/2021
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