Healthcare Provider Details

I. General information

NPI: 1932362647
Provider Name (Legal Business Name): ELIZABETH KELLER HACKENBERGER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MOUNTAIN VIEW AVE
LONGMONT CO
80501-3129
US

IV. Provider business mailing address

PO BOX 800022
KANSAS CITY MO
64180-0022
US

V. Phone/Fax

Practice location:
  • Phone: 303-485-3066
  • Fax: 303-485-3060
Mailing address:
  • Phone: 800-953-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0010136-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: