Healthcare Provider Details

I. General information

NPI: 1497323620
Provider Name (Legal Business Name): SHEILA REPKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MACON AVE
CANON CITY CO
81212-3314
US

IV. Provider business mailing address

243 GLENMOOR RD
CANON CITY CO
81212-2715
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-1618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996576-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: