Healthcare Provider Details

I. General information

NPI: 1891706701
Provider Name (Legal Business Name): LAURIE L MAHAR PMH-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E RAILROAD AVE
FORT MORGAN CO
80701-3365
US

IV. Provider business mailing address

211 W MAIN ST
STERLING CO
80751-3168
US

V. Phone/Fax

Practice location:
  • Phone: 970-867-4924
  • Fax: 970-867-2695
Mailing address:
  • Phone: 970-522-4549
  • Fax: 970-522-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0990620
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPN.0990620-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: