MEDICARE: PAULETTE R WORK RNFA

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	163WR0006X	Registered Nurse First Assistant	105563	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105563	OTHER	CO	REGISTERED NURSE LICENSE

General Provider Information

NPI Number	:	1114150463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULETTE R WORK RNFA

Provider Business Mailing Address
First Line	:	PO BOX 76510
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80970-6510
Country	:	US
Telephone Number	:	719-638-8844
Fax Number	:	719-638-8115

Provider Business Practice Location Address
First Line	:	6280 MOCCASIN PASS CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4442
Country	:	US
Telephone Number	:	719-638-8844
Fax Number	:	719-638-8115

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	09/02/2009

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