NPI | 1275272924 |
---|---|
Entity Type | Organization |
Authorized Contact | JACQUITA JORDAN Owner 719-271-2887 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
363L00000X Nurse Practitioner | |
363LA2100X Nurse Practitioner, Acute Care | |
363LF0000X Nurse Practitioner, Family | |
Enumeration Date | 2022-06-01 |
Last Update Date | 2022-10-18 |