Basic Information
| Provider Information | |||||||||
| NPI: | 1518187301 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO STATE UNIVERSITY HARTSHORN HEALTH SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 732 ROMA VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805256745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703771911 | ||||||||
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| Practice Location | |||||||||
| Address1: | HARTSHORN HEALTH SERVICE | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704917121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NUTTER | ||||||||
| AuthorizedOfficialFirstName: | CECELIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9704911704 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 140641 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
No ID Information.