Healthcare Provider Details

I. General information

NPI: 1821518861
Provider Name (Legal Business Name): STEPHANIE LILLIBRIDGE AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INDIANA ST STE 280
GOLDEN CO
80401-5069
US

IV. Provider business mailing address

2244 E HARMONY RD STE 110
FORT COLLINS CO
80528-3422
US

V. Phone/Fax

Practice location:
  • Phone: 303-216-2661
  • Fax: 720-328-2653
Mailing address:
  • Phone: 970-226-1117
  • Fax: 970-226-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberAPN.0992956-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0992956-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0992956-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: