1093261984 NPI number — AUTUMN DAWN ROWLAND

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093261984 NPI number — AUTUMN DAWN ROWLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROWLAND
Provider First Name:
AUTUMN
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZEGEL
Provider Other First Name:
AUTUMN
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093261984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 S NEVADA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-4273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-249-7751
Provider Business Mailing Address Fax Number:
970-249-5029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
569 32 RD STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81504-6095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-523-3544
Provider Business Practice Location Address Fax Number:
970-434-3422
Provider Enumeration Date:
08/30/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0992499-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0992499NP . This is a "STATE LICENSE - COLORADO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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