Healthcare Provider Details

I. General information

NPI: 1962954172
Provider Name (Legal Business Name): MARGARET EILEEN REARDON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 TENDERFOOT HILL RD STE 255
COLORADO SPRINGS CO
80906-7393
US

IV. Provider business mailing address

15848 LONGMEADOW LN
COLORADO SPRINGS CO
80921-3707
US

V. Phone/Fax

Practice location:
  • Phone: 719-694-9446
  • Fax: 720-694-9436
Mailing address:
  • Phone: 913-526-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberAPN.0002728-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0002728-C-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAP132473
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0002728-C-NP
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0002728-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: