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General NPI Number Information
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NPI Number | 1184010696
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Entity Type | Organization
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Legal Business Name | CANYON WREN FAMILY MEDICINE & WELLNESS, PLLC
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 2345 N 7TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8117
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Country | US
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Telephone | 970-773-5713
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 N 7TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8117
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Country | US
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Telephone | 970-773-5713
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TONYA WREN
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Credential | MD
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Telephone | 970-773-5713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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