Healthcare Provider Details

I. General information

NPI: 1770564908
Provider Name (Legal Business Name): NORTHERN COLORADO GERIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 S SHIELDS ST PMB I-143
FT COLLINS CO
80526-1855
US

IV. Provider business mailing address

2519 S SHIELDS ST PMB I-143
FT COLLINS CO
80526-1855
US

V. Phone/Fax

Practice location:
  • Phone: 970-388-3279
  • Fax: 970-419-4780
Mailing address:
  • Phone: 970-388-3279
  • Fax: 970-419-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76875
License Number StateCO

VIII. Authorized Official

Name: TAMRA MEURER
Title or Position: OWNER
Credential: N.P.
Phone: 970-388-3279