MEDICARE: MS. ANNE PORTER WILFONG FNP

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	363LF0000X	Family Nurse Practitioner	110660	CO

General Provider Information

NPI Number	:	1457561854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE PORTER WILFONG FNP

Provider Business Mailing Address
First Line	:	1225 ELM STREET
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-1887
Country	:	US
Telephone Number	:	303-273-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 17TH ST
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-1824
Country	:	US
Telephone Number	:	303-273-3381
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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