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General NPI Number Information
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NPI Number | 1629609003
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Entity Type | Individual
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Provider Name | IRINA PRATT
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Gender | Female
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 50 BUCK CREEK RD STE 200
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City | AVON
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State | CO
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Zip | 81620-5428
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Country | US
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Telephone | 970-926-6340
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Fax | 970-926-6348
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Provider Business Mailing Address
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Address Line | PO BOX 4330
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City | AVON
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State | CO
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Zip | 81620-4330
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Country | US
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Telephone | 970-926-6340
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Fax | 970-926-6348
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0995070
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License Number State | CO
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