Healthcare Provider Details

I. General information

NPI: 1639073455
Provider Name (Legal Business Name): BRIDGET AESOPH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S LEMAY AVE # 7-139
FORT COLLINS CO
80525-2295
US

IV. Provider business mailing address

2601 S LEMAY AVE # 7-139
FORT COLLINS CO
80525-2295
US

V. Phone/Fax

Practice location:
  • Phone: 970-682-4417
  • Fax:
Mailing address:
  • Phone: 970-682-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: