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NPI Code Detail

MEDICARE: JOANIE MARIE DEATRICH DO

MEDICARE: JOANIE MARIE DEATRICH DO
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
1207QA0505XAdult Medicine Physician0055774CO

General Provider Information

NPI Number : 1346336500
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANIE MARIE DEATRICH DO
Provider Business Mailing Address
First Line : 2818 CHERRYSTONE PL
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-6607
Country : US
Telephone Number : 970-310-3159
Fax Number : 307-778-7559
Provider Business Practice Location Address
First Line : 2360 E PERSHING BLVD
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-5356
Country : US
Telephone Number : 307-778-7555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 10/01/2020

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