Healthcare Provider Details

I. General information

NPI: 1124719349
Provider Name (Legal Business Name): KATELYN EMILY RUSCH M.S., NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

9003 19TH STREET RD
GREELEY CO
80634-5754
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberC-RXN.0101584-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number214828
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN.1636289
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: