Healthcare Provider Details

I. General information

NPI: 1891748505
Provider Name (Legal Business Name): JANET L TARAVELLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 LOMBARDI ST
ERIE CO
80516-6958
US

IV. Provider business mailing address

5691 HOUSEMAN RD
PUEBLO CO
81004-9709
US

V. Phone/Fax

Practice location:
  • Phone: 303-828-0298
  • Fax:
Mailing address:
  • Phone: 719-676-7060
  • Fax: 719-676-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number57243
License Number StateCO

VIII. Authorized Official

Name: JANET LOUISE TARAVELLA
Title or Position: PRES
Credential: CRNFA
Phone: 303-828-0298