MEDICARE: MS. CHRISTIE LEA ILG-SALTER N.P.

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	208000000X	Pediatrics Physician	107156	CO
2	363L00000X	Nurse Practitioner	107156	CO
3	363LS0200X	School Nurse Practitioner	APN.0000372	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508085580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTIE LEA ILG-SALTER N.P.

Provider Business Mailing Address
First Line	:	185 SUTTLE ST
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81303-8276
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 MAIN AVE
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-4638
Country	:	US
Telephone Number	:	970-375-3832
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	11/30/2017

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