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NPI Code Detail

MEDICARE: VICKI SAGRILLO CPNP

MEDICARE: VICKI SAGRILLO CPNP
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
1363LP0200XPediatric Nurse Practitioner63638CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
163638OTHERCOSTATE LICENSE

General Provider Information

NPI Number : 1154309912
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKI SAGRILLO CPNP
Provider Business Mailing Address
First Line : 6190 BARNES RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-2600
Country : US
Telephone Number : 719-596-4502
Fax Number : 719-597-2668
Provider Business Practice Location Address
First Line : 6190 BARNES RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-2600
Country : US
Telephone Number : 719-596-4502
Fax Number : 719-597-2668
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 07/08/2007

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