Healthcare Provider Details

I. General information

NPI: 1316983265
Provider Name (Legal Business Name): NIKITA T. VISCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E PROSPECT RD
FORT COLLINS CO
80525-9718
US

IV. Provider business mailing address

2500 E PROSPECT RD
FORT COLLINS CO
80525-9718
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-0112
  • Fax: 970-493-0521
Mailing address:
  • Phone: 970-493-0112
  • Fax: 970-493-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0035644
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number035644
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: