MEDICARE: HANNA ALLSUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063223790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNA ALLSUP

Provider Business Mailing Address
First Line	:	841 SUNLIGHT PEAK DR
Second Line	:
City	:	SEVERANCE
State	:	CO
Zip	:	80550-4866
Country	:	US
Telephone Number	:	970-980-7268
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 STANFORD RD STE 130
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4679
Country	:	US
Telephone Number	:	970-829-1128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/14/2025

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Directions to “ HANNA ALLSUP ” Practice Location

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