Provider Demographics
NPI:1972049245
Name:DOC
Entity type:Organization
Organization Name:DOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SICOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:719-269-5081
Mailing Address - Street 1:13955 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-9510
Mailing Address - Country:US
Mailing Address - Phone:171-926-9508
Mailing Address - Fax:
Practice Address - Street 1:57500 E HWY 50
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9363
Practice Address - Country:US
Practice Address - Phone:719-269-5081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004895311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0004895OtherDORA