Individual
LATASHA DEANNE MYRIECKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4776 EAGLERIDGE CIR, PUEBLO, CO 81008-2189
(719) 553-1000
Mailing address
1150 LORDS HILL DR, FOUNTAIN, CO 80817-6601
(719) 322-5460
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN0994336NP
CO
Other
Enumeration date
11/28/2018
Last updated
11/28/2018
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