Healthcare Provider Details

I. General information

NPI: 1083487805
Provider Name (Legal Business Name): CHANISE CHRISTOPHER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 W TRILBY RD
FORT COLLINS CO
80526-9650
US

IV. Provider business mailing address

4845 PEARL EAST CIR STE 118 PMB 934664
BOULDER CO
80301-6112
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-4200
  • Fax:
Mailing address:
  • Phone: 970-602-4222
  • Fax: 720-684-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1000919-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: