Healthcare Provider Details

I. General information

NPI: 1366112880
Provider Name (Legal Business Name): ROSALYN WALKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSALYN GRIEDER RN

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 PARKER BLVD
PUEBLO CO
81008-2212
US

IV. Provider business mailing address

PO BOX 9000
PUEBLO CO
81008-9000
US

V. Phone/Fax

Practice location:
  • Phone: 719-553-1804
  • Fax: 833-916-2047
Mailing address:
  • Phone: 719-553-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996937-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: