Healthcare Provider Details

I. General information

NPI: 1144610908
Provider Name (Legal Business Name): BRITTANY LOESER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2877 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-2312
US

IV. Provider business mailing address

8890 N UNION BLVD
COLORADO SPRINGS CO
80920-7799
US

V. Phone/Fax

Practice location:
  • Phone: 719-454-6009
  • Fax: 719-258-1319
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0005123
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: