Basic Information
| Provider Information | |||||||||
| NPI: | 1548698400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCANINCH | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 W DRAKE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704820198 | ||||||||
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| Practice Location | |||||||||
| Address1: | 802 W DRAKE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704820198 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2013 | ||||||||
| LastUpdateDate: | 11/06/2015 | ||||||||
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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 | APN.0991136-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | AG0613044 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363L00000X | APN.0991136-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.