Healthcare Provider Details

I. General information

NPI: 1063551018
Provider Name (Legal Business Name): HOLLEY CABALLES HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E 13TH ST STE 220
LOVELAND CO
80537-5136
US

IV. Provider business mailing address

3702 S TIMBERLINE RD STE A
FORT COLLINS CO
80525-3625
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-5432
  • Fax:
Mailing address:
  • Phone: 970-207-9773
  • Fax: 970-207-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC-APN.0001411-C-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: