Healthcare Provider Details

I. General information

NPI: 1811887508
Provider Name (Legal Business Name): MINA MUIRHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HAXTON DR UNIT 100
FORT COLLINS CO
80525-6213
US

IV. Provider business mailing address

1100 HAXTON DR UNIT 100
FORT COLLINS CO
80525-6213
US

V. Phone/Fax

Practice location:
  • Phone: 970-215-5869
  • Fax:
Mailing address:
  • Phone: 970-215-5869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0115622
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: