Healthcare Provider Details

I. General information

NPI: 1437162351
Provider Name (Legal Business Name): JULIE L MACCLUSKEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST SUITE 100
DURANGO CO
81301-7306
US

IV. Provider business mailing address

1 MERCADO ST SUITE 100
DURANGO CO
81301-7306
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-7977
  • Fax: 970-385-6727
Mailing address:
  • Phone: 970-385-7977
  • Fax: 970-385-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number111654
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: