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General NPI Number Information
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NPI Number | 1205266897
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Entity Type | Individual
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Provider Name | CHAD MICHAEL KOERLIN RN
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Gender | Male
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 1236 E ELIZABETH ST SUITE 1
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City | FORT COLLINS
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State | CO
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Zip | 80524-4000
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Country | US
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Telephone | 970-224-2985
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Fax |
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Provider Business Mailing Address
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Address Line | 1236 E ELIZABETH ST SUITE 1
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City | FORT COLLINS
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State | CO
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Zip | 80524-4000
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Country | US
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Telephone | 970-224-2985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN.0191070
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License Number State | CO
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