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General NPI Number Information
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NPI Number | 1104355015
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Entity Type | Individual
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Provider Name | JUDY CAROL FLETCHER RN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 06/06/2017
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Provider Practice Location Address
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Address Line | 1800 PAVILLION DR
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 970-249-7015
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Fax |
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Provider Business Mailing Address
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Address Line | 265 BLACK SAGE RD
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City | CRAWFORD
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State | CO
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Zip | 81415-9141
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Country | US
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Telephone | 970-270-2790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | RN0068047
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License Number State | CO
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