Provider Demographics
NPI:1437162351
Name:MACCLUSKEY, JULIE L (NP)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:L
Last Name:MACCLUSKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7306
Mailing Address - Country:US
Mailing Address - Phone:970-385-7977
Mailing Address - Fax:970-385-6727
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-385-7977
Practice Address - Fax:970-385-6727
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO111654363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP70116Medicare UPIN
COC477048Medicare ID - Type UnspecifiedPROVIDER NUMBER