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General NPI Number Information
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NPI Number | 1093699357
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Entity Type | Organization
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Legal Business Name | AVALANCHE FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 4272 PROMENADE DR STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-2830
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Country | US
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Telephone | 719-660-1684
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Fax |
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Provider Business Mailing Address
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Address Line | 4272 PROMENADE DR STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-2830
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Country | US
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Telephone | 719-660-1684
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA L PROULX
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Credential | NP
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Telephone | 719-660-1684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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