MEDICARE: NINA KATHRYN HEAD

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	363LF0000X	Family Nurse Practitioner	53336	WY

General Provider Information

NPI Number	:	1437923505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA KATHRYN HEAD

Provider Business Mailing Address
First Line	:	5439 RABBIT CREEK RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3191
Country	:	US
Telephone Number	:	205-389-0397
Fax Number	:

Provider Business Practice Location Address
First Line	:	5439 RABBIT CREEK RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3191
Country	:	US
Telephone Number	:	205-389-0397
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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Directions to “ NINA KATHRYN HEAD ” Practice Location

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