Organization
DOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRUDY ANN SICOTTE ACNP (NURSE PRACTITIONER)
(719) 269-5081
Entity
Organization
Contact information
Practice address
57500 E HWY 50, CANON CITY, CO 81212-9363
(719) 269-5081
Mailing address
13955 MURPHY RD, PEYTON, CO 80831-9510
(171) 926-9508
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
0004895
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004895
DORA
CO
Enumeration date
01/11/2017
Last updated
01/11/2017
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