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General NPI Number Information
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NPI Number | 1831649839
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Entity Type | Organization
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Legal Business Name | WOODLAND PARK FAMILY MEDICINE
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 16222 W US HIGHWAY 24 SUITE 200
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City | WOODLAND PARK
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State | CO
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Zip | 80863-8762
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Country | US
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Telephone | 719-686-2801
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Fax |
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Provider Business Mailing Address
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Address Line | 16222 W US HIGHWAY 24 SUITE 200
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City | WOODLAND PARK
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State | CO
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Zip | 80863-8762
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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 | OFFICE MANAGER
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Name | GENEVA LAY
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Credential |
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Telephone | 719-686-2801
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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 | APN0992468
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License Number State | CO
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