Healthcare Provider Details

I. General information

NPI: 1396834313
Provider Name (Legal Business Name): CHRISTINE SUE SKOW-PUCEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/25/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 PENNONK PLACE SUITE 114
FORT COLLINS CO
80524-3257
US

IV. Provider business mailing address

1025 PENNONK PLACE SUITE 114
FORT COLLINS CO
80524-3257
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8800
  • Fax: 970-495-8820
Mailing address:
  • Phone: 970-495-8800
  • Fax: 970-495-8820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0871
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0002733-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: