MEDICARE: CHRISTA MARIA COOLIDGE

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	163W00000X	Registered Nurse	RN.0125853	CO
2	363L00000X	Nurse Practitioner	APN.0005006-NP	CO
3	363LA2200X	Adult Health Nurse Practitioner	APN.0005006-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730199365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA MARIA COOLIDGE

Provider Business Mailing Address
First Line	:	2767 JANITELL RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4102
Country	:	US
Telephone Number	:	719-365-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2767 JANITELL RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4102
Country	:	US
Telephone Number	:	719-365-2888
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	05/21/2021

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Directions to “ CHRISTA MARIA COOLIDGE ” Practice Location

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