MEDICARE: SUSAN MICHELLE GULYA FNP

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	363LF0000X	Family Nurse Practitioner	24835.1667	WY
2	363LF0000X	Family Nurse Practitioner	APN.0997057-NP	CO
3	202D00000X	Integrative Medicine Physician	APN.0997057-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24835.1667	OTHER	WY	APRN LICENSE

General Provider Information

NPI Number	:	1366961070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MICHELLE GULYA FNP

Provider Business Mailing Address
First Line	:	2955 NEW CENTER PT # 1126
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4426 SLIDE CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-2935
Country	:	US
Telephone Number	:	719-747-2657
Fax Number	:

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	05/12/2024

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