Healthcare Provider Details

I. General information

NPI: 1346285806
Provider Name (Legal Business Name): SUSAN PAIGE ATWOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E PIKES PEAK AVE
COLORADO SPRINGS CO
80903-3631
US

IV. Provider business mailing address

4289 APACHE PLUME DR
COLORADO SPRINGS CO
80920-7637
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-3400
  • Fax: 719-633-3800
Mailing address:
  • Phone: 719-282-8161
  • Fax: 719-633-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number173962
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: