Healthcare Provider Details

I. General information

NPI: 1124937933
Provider Name (Legal Business Name): SUSAN ALEXANDRA FOX APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSIE ALEXANDRA FOX APRN

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 DRY CREEK DR STE 200
LONGMONT CO
80503-6409
US

IV. Provider business mailing address

2432 DERBY HILL DR
LOVELAND CO
80537-7320
US

V. Phone/Fax

Practice location:
  • Phone: 720-279-9098
  • Fax:
Mailing address:
  • Phone: 386-984-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN.1002425-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: