Healthcare Provider Details

I. General information

NPI: 1437156254
Provider Name (Legal Business Name): ALICEMARIE F. SLAVEN-EMOND FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAIN STREET
DELTA CO
81416
US

IV. Provider business mailing address

1025 MAIN STREET
DELTA CO
81416
US

V. Phone/Fax

Practice location:
  • Phone: 970-964-7740
  • Fax: 970-874-6330
Mailing address:
  • Phone: 970-964-7740
  • Fax: 970-874-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0994367-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: