Healthcare Provider Details

I. General information

NPI: 1245275924
Provider Name (Legal Business Name): MARCELLE YVONNE AUTHIER-FRIEDMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3958 N ACADEMY SUITE 108
COLORADO SPRINGS CO
80917
US

IV. Provider business mailing address

821 N SHERIDAN AVE
COLORADO SPRINGS CO
80909
US

V. Phone/Fax

Practice location:
  • Phone: 719-573-8880
  • Fax: 719-573-8885
Mailing address:
  • Phone: 719-475-0483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number712015
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: