NPI 1497397657 · live from the CMS NPI Registry
Advanced Practice Health Clinic
Nurse Practitioner, Family in Pueblo, CO. National Provider Identifier 1497397657, active.
NPI record
| NPI | 1497397657 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 1128 Eagleridge Blvd, Pueblo, CO 81008 |
| Practice phone | 719-778-1414 |
| Mailing address | 378 Kelsey Ct, Florence, CO 81226 |
| Enumerated | October 9, 2019 |
| Last updated | January 6, 2020 |
| Authorized official | Stacey Molinar, Family Nurse Practitioner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinic/Center, Primary Care | 261QP2300X | — |
| Nurse Practitioner, Family primary | 363LF0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.