Healthcare Provider Details

I. General information

NPI: 1922678812
Provider Name (Legal Business Name): MICHELLE MARIE HART AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE SANDT

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S NEVADA AVE
MONTROSE CO
81401-4273
US

IV. Provider business mailing address

10197 CREST VIEW DR
MORRISON CO
80465-2302
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-7751
  • Fax:
Mailing address:
  • Phone: 303-877-1594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0996645-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0996645-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0996645-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: