| 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 |