Healthcare Provider Details

I. General information

NPI: 1871918045
Provider Name (Legal Business Name): ELIZABETH ANN WALTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E STUART ST STE 4101
FORT COLLINS CO
80525-1173
US

IV. Provider business mailing address

PO BOX 212
EATON CO
80615-0212
US

V. Phone/Fax

Practice location:
  • Phone: 970-658-0535
  • Fax:
Mailing address:
  • Phone: 970-350-4606
  • Fax: 970-350-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number75068
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111634
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0992220
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number99220
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: