Healthcare Provider Details

I. General information

NPI: 1912580549
Provider Name (Legal Business Name): JAMES LOGAN MACHIN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WARDENBURG DRIVE
BOULDER CO
80309-7413
US

IV. Provider business mailing address

1900 WARDENBURG DRIVE BOULDER
BOULDER CO
80309-0001
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-5101
  • Fax: 303-492-6861
Mailing address:
  • Phone: 303-492-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996393-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: