Basic Information
| Provider Information | |||||||||
| NPI: | 1215154323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOUTHARD | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2127 E HARMONY RD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702976250 | ||||||||
| FaxNumber: | 9702976260 | ||||||||
| Practice Location | |||||||||
| Address1: | 2127 E HARMONY RD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805283405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702976250 | ||||||||
| FaxNumber: | 9702976260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN-104213 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.