Healthcare Provider Details

I. General information

NPI: 1104355015
Provider Name (Legal Business Name): JUDY CAROL FLETCHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PAVILLION DR
MONTROSE CO
81401
US

IV. Provider business mailing address

265 BLACK SAGE RD
CRAWFORD CO
81415-9141
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-7015
  • Fax:
Mailing address:
  • Phone: 970-270-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN0068047
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: