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General NPI Number Information
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NPI Number | 1396565644
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Entity Type | Organization
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Legal Business Name | SUPERIOR MEDICINE, PLLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 435 S SNOWMASS CIR
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City | SUPERIOR
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State | CO
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Zip | 80027-6119
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Country | US
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Telephone | 720-290-8243
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Fax |
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Provider Business Mailing Address
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Address Line | 435 S SNOWMASS CIR
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City | SUPERIOR
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State | CO
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Zip | 80027-6119
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Country | US
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Telephone | 720-290-8243
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Fax |
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | LORA SHIMA
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Credential | FNP-C
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Telephone | 720-290-8243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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