Healthcare Provider Details

I. General information

NPI: 1194371013
Provider Name (Legal Business Name): MARGARETTA MARIE SPENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 CASTLE CREEK RD STE 201
ASPEN CO
81611-3125
US

IV. Provider business mailing address

405 CASTLE CREEK RD STE 201
ASPEN CO
81611-3125
US

V. Phone/Fax

Practice location:
  • Phone: 970-920-5420
  • Fax: 970-920-5419
Mailing address:
  • Phone: 970-920-5420
  • Fax: 970-920-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number1621869
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: