MEDICARE: TRUMON OTTO CRAFT IV MSN, A-GNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	0995336-NP	CO
2	163WC0200X	Critical Care Medicine Registered Nurse	RN.0169891	CO

General Provider Information

NPI Number	:	1033675004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUMON OTTO CRAFT IV MSN, A-GNP

Provider Business Mailing Address
First Line	:	220 EAST AVE
Second Line	:
City	:	RIFLE
State	:	CO
Zip	:	81650-2332
Country	:	US
Telephone Number	:	970-625-5521
Fax Number	:	970-625-9336

Provider Business Practice Location Address
First Line	:	220 EAST AVE
Second Line	:
City	:	RIFLE
State	:	CO
Zip	:	81650-2332
Country	:	US
Telephone Number	:	970-625-5521
Fax Number	:	970-625-9336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	06/28/2023

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