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General NPI Number Information
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NPI Number | 1558694935
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Entity Type | Individual
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Provider Name | PATTI JO IRENE DEMOTTS NP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 559 VINCENT ST 21ST MEDICAL GROUP
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City | COLORADO SPRINGS
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State | CO
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Zip | 80914-1541
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Country | US
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Telephone | 719-556-1197
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Fax |
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Provider Business Mailing Address
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Address Line | 31 LANGLEY ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80916-5249
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Country | US
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Telephone | 571-484-0057
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 3782-033
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 129992-030
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License Number State | WI
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