Healthcare Provider Details

I. General information

NPI: 1386858678
Provider Name (Legal Business Name): PUEBLO WOMENS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 JERRY MURPHY RD
PUEBLO CO
81001-1045
US

IV. Provider business mailing address

4010 JERRY MURPHY ROAD
PUEBLO CO
81001
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-2229
  • Fax:
Mailing address:
  • Phone: 719-546-2229
  • Fax: 719-583-9069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number67505
License Number StateCO

VIII. Authorized Official

Name: MARSHA L CHRISTMAN
Title or Position: GYN-NP
Credential: NURSE PRACTIONER
Phone: 719-546-2229