MEDICARE: SUSAN PAIGE ATWOOD 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	173962	CO

General Provider Information

NPI Number	:	1346285806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PAIGE ATWOOD NP

Provider Business Mailing Address
First Line	:	4289 APACHE PLUME DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7637
Country	:	US
Telephone Number	:	719-282-8161
Fax Number	:	719-633-3800

Provider Business Practice Location Address
First Line	:	825 E PIKES PEAK AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3631
Country	:	US
Telephone Number	:	719-633-3400
Fax Number	:	719-633-3800

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/29/2012

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