Healthcare Provider Details

I. General information

NPI: 1740249747
Provider Name (Legal Business Name): SHIRLEY ELAINE NIX
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FAIRHURST ST
STERLING CO
80751-4564
US

IV. Provider business mailing address

1441 N 12TH ST
PHOENIX AZ
85006-2837
US

V. Phone/Fax

Practice location:
  • Phone: 970-521-3223
  • Fax: 970-521-3266
Mailing address:
  • Phone: 602-495-4577
  • Fax: 602-417-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34136
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: