Basic Information
| Provider Information | |||||||||
| NPI: | 1922314764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CSU STUDENT HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 POUDRE BAY | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805506109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706866748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 SOUTH DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704917121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2010 | ||||||||
| LastUpdateDate: | 08/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | GLENN | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED NURSE | ||||||||
| AuthorizedOfficialTelephone: | 9704917121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | R.N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | RN-114168 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.