MEDICARE: FRONTIER MEDICINE LLC

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

General Provider Information

NPI Number	:	1578184107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTIER MEDICINE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1235
Second Line	:
City	:	CLIFTON
State	:	CO
Zip	:	81520-1235
Country	:	US
Telephone Number	:
Fax Number	:	949-577-4586

Provider Business Practice Location Address
First Line	:	2472 PATTERSON RD UNIT 5
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1100
Country	:	US
Telephone Number	:	970-773-1602
Fax Number	:	949-577-4586

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	AUTHUMN N SANTELLANA
Credential	:	DNP-FNP-BC
Telephone Number	:	970-773-1602

Provider Enumeration Date	:	05/05/2020
Last Update Date	:	07/12/2022

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Directions to “FRONTIER MEDICINE LLC ” Practice Location

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