| NPI | 1134249964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA LYNN HEAD Nurse Practioner 719-276-3211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 98310) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-08-22 |