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General NPI Number Information
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NPI Number | 1619292331
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Entity Type | Individual
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Provider Name | NISHA ANU PRAKASH M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 400 W 16TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2745
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Country | US
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Telephone | 719-584-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 755
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City | SYLVANIA
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State | OH
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Zip | 43560-0755
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Country | US
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Telephone |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | DR.0054281
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License Number State | CO
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