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4 Corners Children'S Clinic

Nurse Practitioner, Pediatrics in Durango, CO. Organization (NPI-2).

NPI number1144832981
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1144832981
Entity type
Organization (NPI-2)
Legal business name
4 Corners Children'S Clinic
Organization subpart
No
Enumeration date
Aug 22, 2020
Certification date
Aug 22, 2020
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, Pediatrics––Yes

Practice location

555 Rivergate Ste B1-109
Durango, CO 81301-7473

Phone 970-335-9678

Mailing address

555 Rivergate Ste B1-109
Durango, CO 81301-7473

Phone 970-335-9678

Authorized official

Jessica Rensner
Cpnp
9703359678

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