Healthcare Provider Details

I. General information

NPI: 1710515523
Provider Name (Legal Business Name): MADELINE M SYZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RUSH DR
SALIDA CO
81201-9627
US

IV. Provider business mailing address

1000 RUSH DR
SALIDA CO
81201-9627
US

V. Phone/Fax

Practice location:
  • Phone: 719-530-2000
  • Fax:
Mailing address:
  • Phone: 719-530-2434
  • Fax: 719-530-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995951-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1638166
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: