Healthcare Provider Details

I. General information

NPI: 1669498838
Provider Name (Legal Business Name): JOANN M KARGUL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 E 3RD AVE STE 1
DURANGO CO
81301
US

IV. Provider business mailing address

185 SUTTLE ST
DURANGO CO
81303-8276
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2288
  • Fax: 970-335-2280
Mailing address:
  • Phone: 970-335-2232
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number184663
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0005527
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: