MEDICARE: COLLEEN DEIRDRE IHNKEN N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APN.0004820	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN-85210	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1124193586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN DEIRDRE IHNKEN N.P.

Provider Business Mailing Address
First Line	:	PO BOX 40,000
Second Line	:
City	:	VAIL
State	:	CO
Zip	:	81658
Country	:	US
Telephone Number	:	970-949-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 BEARD CREEK RD
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-6426
Country	:	US
Telephone Number	:	970-949-6100
Fax Number	:	970-470-6683

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	03/02/2023

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