Individual
CARLY PECORIELLO PRUDIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
480 WOLVERINE DR STE 3, BAYFIELD, CO 81122-9653
(970) 764-9150
Mailing address
480 WOLVERINE DR STE 3, BAYFIELD, CO 81122-9653
(707) 649-1509
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-79812
NM
363L00000X
Nurse Practitioner
C-APN.0003335-C-NP
CO
363LF0000X
Family Nurse Practitioner
568903
NM
363LF0000X
Family Nurse Practitioner
Primary
C-APN.0003335-C-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000198265
—
CO
Enumeration date
07/15/2019
Last updated
07/21/2023
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