Healthcare Provider Details

I. General information

NPI: 1013367507
Provider Name (Legal Business Name): GAIL R LOGUE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL HUTTON

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E ELIZABETH ST STE 2
FORT COLLINS CO
80524-4044
US

IV. Provider business mailing address

1120 E ELIZABETH ST STE 2
FORT COLLINS CO
80524-4044
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-9193
  • Fax:
Mailing address:
  • Phone: 970-493-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0117095
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-63996
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0002856-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: