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TY SHETTRON FNP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1659709574

Individual Registrant:
 TY  SHETTRON FNP
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

Contact information for business:
373 E 10TH AVE  SPRINGFIELD, CO 81073-1622 US
Tel: 719-523-6628  Fax: 719-523-4513

Registration Information:
NPI: 1659709574
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
CO0990954

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
89279077CO05




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