Healthcare Provider Details

I. General information

NPI: 1194135913
Provider Name (Legal Business Name): DANA ELIZABETH HATTEBERG RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PARKSIDE DRIVE
COLORADO SPRINGS CO
80910
US

IV. Provider business mailing address

220 RUSKIN DRIVE
COLORADO SPRINGS CO
80910
US

V. Phone/Fax

Practice location:
  • Phone: 719-447-4740
  • Fax: 719-447-4792
Mailing address:
  • Phone: 719-572-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1623625
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: