Healthcare Provider Details

I. General information

NPI: 1417404906
Provider Name (Legal Business Name): ANSLEY SMITHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 DUBLIN BLVD
COLORADO SPRINGS CO
80918-1358
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 195-929-8907
  • Fax: 719-264-7908
Mailing address:
  • Phone: 970-624-2417
  • Fax: 970-652-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992727-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.1641992
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: