Healthcare Provider Details

I. General information

NPI: 1184603219
Provider Name (Legal Business Name): SYLVIA ANN GARVIN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 COCHRANE CR
FT. CARSON CO
80913
US

IV. Provider business mailing address

2606 WILLARD DR
COLORADO SPRINGS CO
80911-1056
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7030
  • Fax:
Mailing address:
  • Phone: 719-390-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number20004
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: