Provider Demographics
NPI:1609835057
Name:BELANGER-SHUGART, ELIZABETH B (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:BELANGER-SHUGART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4592
Mailing Address - Country:US
Mailing Address - Phone:970-384-7291
Mailing Address - Fax:970-384-7293
Practice Address - Street 1:1052 SUN KING DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPGS
Practice Address - State:CO
Practice Address - Zip Code:81601-9260
Practice Address - Country:US
Practice Address - Phone:734-330-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO181568363LF0000X, 363LF0000X
MIES187079207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO304952Medicare PIN
COCO304791Medicare PIN
COCO304952Medicare PIN