Healthcare Provider Details

I. General information

NPI: 1508945544
Provider Name (Legal Business Name): SHIRLEY I CARLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR SUITE 400
VAIL CO
81657-5242
US

IV. Provider business mailing address

181 W MEADOW DR SUITE 400
VAIL CO
81657-5242
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1100
  • Fax: 970-479-5861
Mailing address:
  • Phone: 970-476-1100
  • Fax: 970-479-5861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number93254
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: