Healthcare Provider Details

I. General information

NPI: 1285655191
Provider Name (Legal Business Name): FELICIA ANNA SOCKOL-GUEST F. N. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W SOUTH BOULDER RD SUITE 110
LAFAYETTE CO
80026-2752
US

IV. Provider business mailing address

345 MAXWELL AVE
BOULDER CO
80304-3972
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-7555
  • Fax: 303-666-1982
Mailing address:
  • Phone: 303-544-5783
  • Fax: 303-441-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number119463
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: