Provider Demographics
NPI:1811422082
Name:DOCTOR NURSE PRACTICE, LLC
Entity Type:Organization
Organization Name:DOCTOR NURSE PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN, FNP-BC
Authorized Official - Phone:970-312-7000
Mailing Address - Street 1:1921 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8533
Mailing Address - Country:US
Mailing Address - Phone:970-312-7000
Mailing Address - Fax:
Practice Address - Street 1:1921 N 17TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8533
Practice Address - Country:US
Practice Address - Phone:970-312-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992346-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO494154ZUSRMedicare UPIN