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General NPI Number Information
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NPI Number | 1467225730
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Entity Type | Organization
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Legal Business Name | COLORADO STATE UNIVERSITY PUEBLO
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 2200 BONFORTE BLVD # 172
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City | PUEBLO
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State | CO
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Zip | 81001-4901
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Country | US
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Telephone | 719-549-2830
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Fax | 719-549-2646
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Provider Business Mailing Address
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Address Line | 2200 BONFORTE BLVD # 172
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City | PUEBLO
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State | CO
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Zip | 81001-4901
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Country | US
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Telephone | 719-549-2830
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Fax | 719-549-2646
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Authorized Official
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Title or Position | ASSISTANT DEAN
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Name | MS. CAROLYN KAY DAUGHERTY
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Credential | FNP-BC
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Telephone | 719-549-2830
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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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