=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356801443
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIANNE WEBB APN RXN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2019
-----------------------------------------------------
Last Update Date | 05/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 S LINCOLN AVE
-----------------------------------------------------
City | HAXTUN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80731-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-835-1545
-----------------------------------------------------
Fax | 303-872-4884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 201
-----------------------------------------------------
City | HAXTUN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80731-0201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-835-1545
-----------------------------------------------------
Fax | 303-872-4884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIANNE WEBB
-----------------------------------------------------
Credential | APN, RXN
-----------------------------------------------------
Telephone | 303-835-1545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------