Basic Information
| Provider Information | |||||||||
| NPI: | 1629023130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOLEY | ||||||||
| FirstName: | ELVIRA | ||||||||
| MiddleName: | GARRUCHO | ||||||||
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| OtherLastName: | GARRUCHO | ||||||||
| OtherFirstName: | ELVIRA | ||||||||
| OtherMiddleName: | DIONELA | ||||||||
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| OtherCredential: | ADULT NURSE PRACTITI | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | EVANS ARMY COMMUNITY HOSPITAL(EACH)USA MEDDAC | ||||||||
| Address2: | BLDG 7600,1650 COCHRANE CIRCLE,ATTN: CREDENTIALS OFFICE | ||||||||
| City: | FT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267844 | ||||||||
| FaxNumber: | 7195267984 | ||||||||
| Practice Location | |||||||||
| Address1: | EVANS ARMY COMMUNITY HOSPITAL(EACH) USA MEDDAC | ||||||||
| Address2: | BLDG 7600,1650COCHRANE CIRCLE,ICU | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 92183 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.