Healthcare Provider Details

I. General information

NPI: 1174596282
Provider Name (Legal Business Name): MICHAEL BECK-GIFFORD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 BIGHORN RD
FORT COLLINS CO
80525
US

IV. Provider business mailing address

2025 BIGHORN RD
FORT COLLINS CO
80525-3480
US

V. Phone/Fax

Practice location:
  • Phone: 970-229-9800
  • Fax: 970-229-1421
Mailing address:
  • Phone: 970-229-9800
  • Fax: 970-229-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number768
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: