Healthcare Provider Details

I. General information

NPI: 1063812113
Provider Name (Legal Business Name): MARY LOUISE ELLER CONTE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 E HARMONY RD SUITE 110
FORT COLLINS CO
80528-3421
US

IV. Provider business mailing address

2244 E HARMONY RD SUITE 110
FORT COLLINS CO
80528-3421
US

V. Phone/Fax

Practice location:
  • Phone: 970-658-5111
  • Fax: 970-226-0251
Mailing address:
  • Phone: 970-658-5111
  • Fax: 970-226-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0991357-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: