| NPI | 1114535879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOCELYN REEVES Provider 719-459-0981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2022-07-24 |