Basic Information
Provider Information
NPI: 1467977124
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BISPO
FirstName: CAROLA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BISIPO
OtherFirstName: CAROLA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 41 MONTEBELLO RD STE 200
Address2:  
City: PUEBLO
State: CO
PostalCode: 810011366
CountryCode: US
TelephoneNumber: 7195452746
FaxNumber: 7195429638
Practice Location
Address1: 1302 CHINOOK LN
Address2:  
City: PUEBLO
State: CO
PostalCode: 810011851
CountryCode: US
TelephoneNumber: 7195452746
FaxNumber: 7195429638
Other Information
ProviderEnumerationDate: 08/03/2017
LastUpdateDate: 08/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN.0190685COY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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