Provider Demographics
NPI:1205003076
Name:EYTCHISON, AGNES MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:MARIE
Last Name:EYTCHISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:MARIE
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 THREE SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8296
Mailing Address - Country:US
Mailing Address - Phone:970-764-3775
Mailing Address - Fax:970-764-3789
Practice Address - Street 1:1010 THREE SPRINGS BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8296
Practice Address - Country:US
Practice Address - Phone:709-764-3390
Practice Address - Fax:970-764-3399
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO176415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily