Healthcare Provider Details

I. General information

NPI: 1245290808
Provider Name (Legal Business Name): CARLA J URAN MSN FNP C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 DEL SOL DRIVE
ALAMOSA CO
81101
US

IV. Provider business mailing address

622 DEL SOL DRIVE
ALAMOSA CO
81101
US

V. Phone/Fax

Practice location:
  • Phone: 719-587-6800
  • Fax: 719-587-6819
Mailing address:
  • Phone: 719-587-6800
  • Fax: 719-587-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number91368
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: