Healthcare Provider Details

I. General information

NPI: 1922685189
Provider Name (Legal Business Name): ABBEY AAROE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LATIGO LN STE D
CANON CITY CO
81212-8115
US

IV. Provider business mailing address

PO BOX 1868
CANON CITY CO
81215-1868
US

V. Phone/Fax

Practice location:
  • Phone: 719-371-0000
  • Fax: 888-965-6893
Mailing address:
  • Phone: 719-896-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996398-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: