ERIC RENICKER (NPI# 1679629513) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1679629513 |
Entity Type | Individual |
Full Name | ERIC RENICKER |
Credential | N.P. |
Practice Address |
1302 Chinook Ln Pueblo CO 81001-1851 |
Mailing Address |
41 Montebello Rd Ste 202 Pueblo CO 81001-1366 |
Practice Telephone | 7195452746 |
Practice Fax Number | 7195429638 |
Mailing Telephone | 7195452746 |
Mailing Fax Number | 7195429638 |
Enumeration Date | 2007-01-25 |
Last Update Date | 2018-05-03 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 163W00000X | Registered Nurse | 140944 | CO | Nursing Service Providers |
N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RXN.0100732-NP | CO | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
0990535-NP | CO | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
1302 CHINOOK LN |
City | PUEBLO |
State | CO |
Zip Code | 81001-1851 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053487876 | Vanessa Benavidez | Specialist/Technologist, Other | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2006-11-24 |
1194326314 | Roland Valdez | Counselor | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-11-04 |
1871191270 | Ariana Gallegos | Registered Nurse | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-10-16 |
1083212492 | Nia Gomez | Registered Nurse | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-10-16 |
1396343513 | Kaylene Medina | Counselor | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-10-09 |
1396342283 | Health Solutions | Clinic/Center | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-10-05 |
1922617281 | Barbara Miller | Registered Nurse | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-07-23 |
1790394062 | Jo Piano | Registered Nurse | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-07-23 |
1427667708 | Reynalda Garoutte | Registered Nurse | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-07-23 |
1245848969 | Jennifer Andrews | Registered Nurse | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2020-07-20 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588222863 | 1111 Bonforte Opco LLC | Respite Care | 855 Hunter Dr., Pueblo, CO 81001 | 2019-06-03 |
1992276026 | Andrew Benjamin Basham | Counselor | 1003 Rupple St Pueblo Co 81001, 606, Pueblo, CO 81001 | 2018-12-16 |
1316456981 | Amy R Leibli | Nurse Practitioner | 1080 Chinook Lane, Pueblo, CO 81001 | 2017-09-26 |
1457781262 | Ron Concialdi | Dentist | 2037 Jerry Murphy Rd., Pueblo, CO 81001 | 2013-11-14 |
1609146950 | Natasha Liette Mondragon | Registered Nurse | 1302 E. 5th, Pueblo, CO 81001 | 2012-01-04 |
1023303575 | Malinda Lee Davis | Registered Nurse | 1302 E 5th, Pueblo, CO 81001 | 2011-06-13 |
1679876429 | Michael Edward Leyba | Substance Abuse Rehabilitation Facility | 4 Montebello Rd., Pueblo, CO 81001 | 2010-12-17 |
1609008796 | Laura Ann Mcmahon | Nurse Practitioner | 4020 Jerry Murphy Rd/, Pueblo, CO 81001 | 2009-08-21 |
1730380882 | Corrine Stella Tafoya | Counselor | 44 Calhoun Rd, Pueblo, CO 81001 | 2007-05-29 |
1518171008 | George Henry Beck | Dentist | 1700 N Salem Ave, Suite A, Pueblo, CO 81001 | 2007-05-10 |
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Taxonomy Code | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1972050615 | Jodi R Trujillo | Nurse Practitioner | 37 S Briarwood Pl, Pueblo, CO 81005-1803 | 2016-09-09 |
1851831846 | Annabelle Florez | Nurse Practitioner | 1600 W 24th St, Pueblo, CO 81003-1411 | 2017-02-24 |
1871950493 | Wendy Wade | Nurse Practitioner | 1304 Chinook Ln, Pueblo, CO 81001-1851 | 2016-01-27 |
1437554557 | Alison Shapiro | Nurse Practitioner | 56 Club Manor Drive, Suite 100, Pueblo, CO 81008-1685 | 2014-10-31 |
1114357183 | Leslie Ann Branick Morrow | Nurse Practitioner | 1304 Chinook Ln, Pueblo, CO 81001-1851 | 2013-11-12 |
1811233448 | Slawomir Tycner | Nurse Practitioner | 1600 W 24th St, Pueblo, CO 81003-1411 | 2012-12-31 |
1760730295 | Brenda Jean Mcbride-wilson | Nurse Practitioner | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2012-08-15 |
1578810750 | Lorrie J. Hoffman | Nurse Practitioner | 1600 W 24th St, Pueblo, CO 81003-1411 | 2012-08-07 |
1013283241 | Monica A Flynn | Nurse Practitioner | 41 Montebello Rd, Pueblo, CO 81001-1379 | 2012-04-02 |
1073833273 | Janice Mary Whiting | Nurse Practitioner | 1304 Chinook Ln, Pueblo, CO 81001-1851 | 2010-06-10 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.