Basic Information
| Provider Information | |||||||||
| NPI: | 1386858678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUEBLO WOMENS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4010 JERRY MURPHY ROAD | ||||||||
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| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195462229 | ||||||||
| FaxNumber: | 7195839069 | ||||||||
| Practice Location | |||||||||
| Address1: | 4010 JERRY MURPHY RD | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810011045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195462229 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTMAN | ||||||||
| AuthorizedOfficialFirstName: | MARSHA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | GYN-NP | ||||||||
| AuthorizedOfficialTelephone: | 7195462229 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NURSE PRACTIONER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 67505 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.