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General NPI Number Information
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NPI Number | 1174398515
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Entity Type | Organization
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Legal Business Name | HALF MOON HEALTH AND WELLNESS, LTD.
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 07/05/2025
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Provider Practice Location Address
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Address Line | 1530 55TH ST STE 123
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City | BOULDER
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State | CO
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Zip | 80303-1256
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Country | US
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Telephone | 720-477-6699
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Fax | 833-973-4351
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Provider Business Mailing Address
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Address Line | 1530 55TH ST STE 123
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City | BOULDER
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State | CO
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Zip | 80303-1256
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Country | US
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Telephone | 720-477-6699
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. KRISTINA R GUTZMAN
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Credential | FNP-C
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Telephone | 805-400-7747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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