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General NPI Number Information
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NPI Number | 1275708844
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Entity Type | Individual
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Provider Name | KELLY JO FABRIZIUS SAC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 200 EXEMPLA CIR
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City | LAFAYETTE
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State | CO
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Zip | 80026-3370
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Country | US
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Telephone | 970-674-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 508 MALLARD DR
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City | WINDSOR
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State | CO
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Zip | 80550-2923
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Country | US
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Telephone | 970-674-9766
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | CO8-0320A
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License Number State | CO
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