Healthcare Provider Details

I. General information

NPI: 1427284470
Provider Name (Legal Business Name): PSYCH ON HEELS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 KOKOPELLI BLVD
FRUITA CO
81521-6305
US

IV. Provider business mailing address

2754 COMPASS DR SUITE 300
GRAND JUNCTION CO
81506-8714
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-1686
  • Fax:
Mailing address:
  • Phone: 970-254-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number173198
License Number StateCO

VIII. Authorized Official

Name: SHERRIE GLASSMEYER
Title or Position: OWNER
Credential:
Phone: 970-254-1686