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TY SHETTRON FNP
Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1659709574
Individual Registrant: TY SHETTRON FNP
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
900 CHURCH ST SPRINGFIELD, CO 81073-1636 US
Tel: 719-523-6628 Fax: 719-523-4513
Tel: 719-523-6628 Fax: 719-523-4513
Contact information for business:
373 E 10TH AVE SPRINGFIELD, CO 81073-1622 US
Tel: 719-523-6628 Fax: 719-523-4513
Tel: 719-523-6628 Fax: 719-523-4513
Registration Information:
NPI: 1659709574
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Family | CO | 0990954 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 89279077 | CO | 05 |
