Healthcare Provider Details

I. General information

NPI: 1205665437
Provider Name (Legal Business Name): HANNAH-MARIE AERTS LONG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 PEARL ST STE 106
BOULDER CO
80302-3826
US

IV. Provider business mailing address

2795 PEARL ST STE 106
BOULDER CO
80302-3826
US

V. Phone/Fax

Practice location:
  • Phone: 720-961-9700
  • Fax:
Mailing address:
  • Phone: 720-961-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999999-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: