MEDICARE: CAROLYN K HACKETT NP

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	363LG0600X	Gerontology Nurse Practitioner	56351	CO

General Provider Information

NPI Number	:	1326041492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN K HACKETT NP

Provider Business Mailing Address
First Line	:	175 S UNION BLVD
Second Line	:	SUITE # 350
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3113
Country	:	US
Telephone Number	:	719-633-5515
Fax Number	:	719-471-2258

Provider Business Practice Location Address
First Line	:	175 S UNION BLVD
Second Line	:	SUITE # 350
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3113
Country	:	US
Telephone Number	:	719-633-5515
Fax Number	:	719-471-2258

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/06/2008

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