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General NPI Number Information
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NPI Number | 1215853874
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Entity Type | Individual
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Provider Name | TRACY ANN FONTECCHIO RN
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Gender | Female
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Dates
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Enumeration Date | 06/27/2026
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Last Update Date | 06/27/2026
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Provider Practice Location Address
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Address Line | 730 S 8TH ST
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City | CANON CITY
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State | CO
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Zip | 81212-4906
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Country | US
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Telephone | 719-251-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 369 W MANGRUM DR
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City | PUEBLO WEST
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State | CO
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Zip | 81007-1819
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Country | US
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Telephone |
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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 | 163WM0102X
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Taxonomy Name | Maternal Newborn Registered Nurse
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License Number | RN.0105898
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License Number State | CO
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