Healthcare Provider Details

I. General information

NPI: 1083971873
Provider Name (Legal Business Name): SHELLY LYNN DUFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 CORPORATE DR
COLORADO SPRINGS CO
80919-1941
US

IV. Provider business mailing address

5901 CORPORATE DR
COLORADO SPRINGS CO
80919-1941
US

V. Phone/Fax

Practice location:
  • Phone: 719-355-1956
  • Fax: 719-355-1958
Mailing address:
  • Phone: 719-355-1956
  • Fax: 719-355-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number150683
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: