Healthcare Provider Details

I. General information

NPI: 1225173321
Provider Name (Legal Business Name): ANN LAWRENCE WHITLOCK RN,MSN,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N CASCADE AVE
COLORADO SPRINGS CO
80903-2367
US

IV. Provider business mailing address

324 FARRAGUT AVE
COLORADO SPRINGS CO
80909-5632
US

V. Phone/Fax

Practice location:
  • Phone: 719-389-6384
  • Fax: 719-389-6928
Mailing address:
  • Phone: 719-630-8215
  • Fax: 719-630-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number54593
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: