Provider Demographics
NPI:1629023130
Name:COOLEY, ELVIRA GARRUCHO
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:GARRUCHO
Last Name:COOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELVIRA
Other - Middle Name:DIONELA
Other - Last Name:GARRUCHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADULT NURSE PRACTITI
Mailing Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL(EACH)USA MEDDAC
Mailing Address - Street 2:BLDG 7600,1650 COCHRANE CIRCLE,ATTN: CREDENTIALS OFFICE
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-526-7844
Mailing Address - Fax:719-526-7984
Practice Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL(EACH) USA MEDDAC
Practice Address - Street 2:BLDG 7600,1650COCHRANE CIRCLE,ICU
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-7020
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92183363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health