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General NPI Number Information
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NPI Number | 1922614494
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Entity Type | Individual
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Provider Name | KRISTA MICHELLE MAVETY APN
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Gender | Female
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 2685 DUBLIN BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1358
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Country | US
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Telephone | 719-592-9890
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Fax | 719-264-7910
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Provider Business Mailing Address
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Address Line | 2685 DUBLIN BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1358
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Country | US
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Telephone | 719-592-9890
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Fax | 719-264-7910
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0995842-NP
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License Number State | CO
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