Healthcare Provider Details

I. General information

NPI: 1033203401
Provider Name (Legal Business Name): ELLEN W CALL CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 US HIGHWAY 285
LA JARA CO
81140-0639
US

IV. Provider business mailing address

P.O. BOX 639 19021 US HIGHWAY 285
LA JARA CO
81140-0639
US

V. Phone/Fax

Practice location:
  • Phone: 719-274-6000
  • Fax: 719-274-6038
Mailing address:
  • Phone: 719-274-6000
  • Fax: 719-274-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR22496
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP00382
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20016
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: