Healthcare Provider Details

I. General information

NPI: 1922005651
Provider Name (Legal Business Name): SUSAN SEYDOR NELSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN SEYDOR

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 KEN PRATT BLVD STE 200
LONGMONT CO
80501-6568
US

IV. Provider business mailing address

PO BOX 911057
DENVER CO
80291-1057
US

V. Phone/Fax

Practice location:
  • Phone: 303-649-3500
  • Fax: 303-649-3501
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0056543
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0000027-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: