Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 83622 | CO |
NPI | 1184673337 |
---|---|
Provider Name | Kelli L Beckvermit-Prine |
First Address | Erie, CO 80516-9733 |
Second Address | Erie, CO 80516-9733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 04/04/2013 |