Healthcare Provider Details

I. General information

NPI: 1275835530
Provider Name (Legal Business Name): STEPHANIE CC YU CHON RN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 E WOODMEN RD STE 100
COLORADO SPRINGS CO
80920-8075
US

IV. Provider business mailing address

4190 E WOODMEN RD STE 100
COLORADO SPRINGS CO
80920-8075
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-4455
  • Fax: 719-418-2123
Mailing address:
  • Phone: 719-632-4455
  • Fax: 719-633-4613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number590290
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRXN0101155NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number991605
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: