Healthcare Provider Details

I. General information

NPI: 1205684420
Provider Name (Legal Business Name): CHANDLER RENE BICKFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WASHINGTON AVE
MANITOU SPRINGS CO
80829-1833
US

IV. Provider business mailing address

305 WASHINGTON AVE
MANITOU SPRINGS CO
80829-1833
US

V. Phone/Fax

Practice location:
  • Phone: 719-282-5357
  • Fax:
Mailing address:
  • Phone: 719-282-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999647-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: