| NPI | 1902275712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GAUGHAN Member, Practitioner 719-494-5123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2021-02-03 |