Healthcare Provider Details

I. General information

NPI: 1629609003
Provider Name (Legal Business Name): IRINA PRATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3827 LUPINE DR
VAIL CO
81657-4886
US

IV. Provider business mailing address

3827 LUPINE DR
VAIL CO
81657-4886
US

V. Phone/Fax

Practice location:
  • Phone: 970-926-6340
  • Fax: 970-926-6348
Mailing address:
  • Phone: 970-926-6340
  • Fax: 970-926-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0995070
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: