Organization
LOMA VISTA GENERAL AND FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARION LEE SCHMUCKER M.D. (OWNER)
(719) 384-8181
Entity
Organization
Contact information
Practice address
2201 SAN JUAN AVE, LA JUNTA, CO 81050-3323
(719) 384-8181
(719) 384-4872
Mailing address
2201 SAN JUAN AVE, LA JUNTA, CO 81050-3323
(719) 384-8181
(719) 384-4872
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0992269-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0992269-NP
COLORADO STATE LICENSE
CO
Enumeration date
04/05/2016
Last updated
04/05/2016
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