Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RXP-100158 | CO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 6013 | CO |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NP-6013 | CO |
NPI | 1023331477 |
---|---|
Provider Name | Dr. Fredi Shae Prochoda |
First Address | Woodland Park, CO 80863-9460 |
Second Address | Greenwood Village, CO 80111-1629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2010 |
Last Update Date | 08/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21102384 | MEDICAID GROUP NUMBER (01) | CO |
38303787 | (05) | CO |