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STARLA SECREST PAC
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1609812643
Individual Registrant: STARLA SECREST PAC
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
100 PIONEERS MEDICAL CENTER DR MEEKER, CO 81641-3181 US
Tel: 970-878-4014 Fax: 970-878-0019
Tel: 970-878-4014 Fax: 970-878-0019
Contact information for business:
100 PMC DR MEEKER, CO 81641-3181 US
Tel: 970-878-4014 Fax: 970-878-0019
Tel: 970-878-4014 Fax: 970-878-0019
Registration Information:
NPI: 1609812643
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | CO | 1495 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 78105544 | CO | 05 |
