Healthcare Provider Details

I. General information

NPI: 1952785610
Provider Name (Legal Business Name): CHRISTINE MARIE OBERMAIER N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 48TH ST STE 200
BOULDER CO
80301-2712
US

IV. Provider business mailing address

5450 WESTERN AVE SUITE B
BOULDER CO
80301-2709
US

V. Phone/Fax

Practice location:
  • Phone: 303-494-5263
  • Fax: 303-494-5265
Mailing address:
  • Phone: 303-415-7450
  • Fax: 303-494-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991619-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: