Healthcare Provider Details

I. General information

NPI: 1023930484
Provider Name (Legal Business Name): LETICIA BUSWELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 MAIN ST
CANON CITY CO
81212-3731
US

IV. Provider business mailing address

55 TANNER PKWY
CANON CITY CO
81212-9418
US

V. Phone/Fax

Practice location:
  • Phone: 719-457-6537
  • Fax:
Mailing address:
  • Phone: 970-218-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.1002215-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: