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General NPI Number Information
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NPI Number | 1386924769
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Entity Type | Organization
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Legal Business Name | DINO-PEDS MANAGEMENT GROUP
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 1190 BOOKCLIFF AVE #104
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8133
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Country | US
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Telephone | 970-242-7060
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Fax | 970-242-6198
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Provider Business Mailing Address
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Address Line | 1190 BOOKCLIFF AVE #104
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8133
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Country | US
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Telephone | 970-242-7060
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Fax | 970-242-6198
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CRYSTAL CAMERON
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Credential |
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Telephone | 970-242-7060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NP990086
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License Number State | CO
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