Healthcare Provider Details

I. General information

NPI: 1629388517
Provider Name (Legal Business Name): CYNTHIA RENEE' MOREHEAD-LEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 S NORWOOD AVE
PUEBLO CO
81001-5801
US

IV. Provider business mailing address

721 S NORWOOD AVE
PUEBLO CO
81001-5801
US

V. Phone/Fax

Practice location:
  • Phone: 888-492-0677
  • Fax: 866-493-9431
Mailing address:
  • Phone: 888-492-0677
  • Fax: 866-493-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number196840
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: