Healthcare Provider Details

I. General information

NPI: 1972139467
Provider Name (Legal Business Name): ALPENGLOW PSYCH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 W 15TH ST STE 3
LOVELAND CO
80538-3551
US

IV. Provider business mailing address

PO BOX 272213
FORT COLLINS CO
80527-2213
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-4389
  • Fax:
Mailing address:
  • Phone: 970-310-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. COLLIN MICHAEL ZANDER
Title or Position: OWNER
Credential: PMHNP-BC, FNP-BC
Phone: 970-310-4389