Basic Information
| Provider Information | |||||||||
| NPI: | 1730637463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONGSHORE | ||||||||
| FirstName: | ELIZABETH | ||||||||
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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 | ||||||||
| FaxNumber: | 9704829148 | ||||||||
| Practice Location | |||||||||
| Address1: | 802 W DRAKE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704820198 | ||||||||
| FaxNumber: | 9704829148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2016 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN.0992558-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | APN.0992558-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.