Organization
BEEWELL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICKLAUS RENDLER (CREDENTIALING AND BUSINESS MANAGER)
(719) 251-5132
Entity
Organization
Contact information
Practice address
401 MICHIGAN ST, PUEBLO, CO 81004-2138
(719) 251-5132
Mailing address
401 MICHIGAN ST, PUEBLO, CO 81004-2138
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/07/2024
Last updated
10/25/2024
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