Healthcare Provider Details

I. General information

NPI: 1619940657
Provider Name (Legal Business Name): EILEEN FLAHERTY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 REDTAIL HAWK DR
ESTES PARK CO
80517-9780
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 970-586-9230
  • Fax: 970-586-0292
Mailing address:
  • Phone: 303-286-4560
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0001979-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: