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General NPI Number Information
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NPI Number | 1780919712
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Entity Type | Organization
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Legal Business Name | PINE RIVER HEALTH CARE, INC.
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 480 WOLVERINE DR #2B
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City | BAYFIELD
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State | CO
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Zip | 81122-9653
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Country | US
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Telephone | 970-884-5173
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Fax | 970-884-0123
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Provider Business Mailing Address
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Address Line | 480 WOLVERINE DR #2B
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City | BAYFIELD
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State | CO
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Zip | 81122-9653
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Country | US
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Telephone | 970-884-5173
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Fax | 970-884-0123
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Authorized Official
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Title or Position | OWNER, NURSE PRACTITIONER
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Name | MRS. NANCY BROOKER
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Credential | CNP
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Telephone | 970-884-5173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 174732
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 174732
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 174732
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 174732
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License Number State | CO
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