Basic Information
| Provider Information | |||||||||
| NPI: | 1225250004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARTSHORN HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4459 EAGLE LK S | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805248609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704161996 | ||||||||
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| Practice Location | |||||||||
| Address1: | HARTSHORN HEALTH CTR | ||||||||
| Address2: | COLORADO STATE UNIVERSITY | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704917121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OLSEN | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | VICTORIA | ||||||||
| AuthorizedOfficialTitleorPosition: | R.N. B.S.N. | ||||||||
| AuthorizedOfficialTelephone: | 9704161996 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1000X | 111417 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Student Health |
No ID Information.