| NPI | 1285990937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDI SHAE PROCHODA Owner, Provider 719-444-0250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 6013) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2023-03-07 |