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General NPI Number Information
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NPI Number | 1215667936
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Entity Type | Organization
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Legal Business Name | TRIFECTA FAMILY WELLNESS LLC
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 805 EAGLERIDGE BLVD STE 150
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City | PUEBLO
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State | CO
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Zip | 81008-2194
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Country | US
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Telephone | 719-627-4287
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Fax | 719-220-7658
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Provider Business Mailing Address
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Address Line | 805 EAGLERIDGE BLVD STE 150
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City | PUEBLO
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State | CO
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Zip | 81008-2194
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Country | US
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Telephone | 719-627-4287
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Fax | 719-220-7658
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Authorized Official
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Title or Position | OWNER
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Name | BRANDIE QUICK
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Credential | FNP-C
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Telephone | 719-468-1569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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