Healthcare Provider Details

I. General information

NPI: 1851389613
Provider Name (Legal Business Name): NORTHERN COLORADO ANESTHESIA PROFESSIONALS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/01/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 AUTOMATION WAY STE 103
FORT COLLINS CO
80525-5738
US

IV. Provider business mailing address

3702 AUTOMATION WAY SUITE 103
FORT COLLINS CO
80525-5738
US

V. Phone/Fax

Practice location:
  • Phone: 970-224-2985
  • Fax: 970-223-1118
Mailing address:
  • Phone: 970-224-2985
  • Fax: 970-223-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAWN WOTOWEY
Title or Position: CEO
Credential:
Phone: 970-224-2985