Healthcare Provider Details

I. General information

NPI: 1922945922
Provider Name (Legal Business Name): CLEARY WUNDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RIM DR
DURANGO CO
81301-3999
US

IV. Provider business mailing address

103 ELK TRAIL RD
DURANGO CO
81301-6952
US

V. Phone/Fax

Practice location:
  • Phone: 831-234-1343
  • Fax:
Mailing address:
  • Phone: 831-234-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0995131-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: