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General NPI Number Information
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NPI Number | 1326853193
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Entity Type | Organization
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Legal Business Name | WHOLE MOON HEALING LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/16/2025
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Provider Practice Location Address
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Address Line | 2519 S SHIELDS ST
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City | FORT COLLINS
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State | CO
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Zip | 80526-1855
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Country | US
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Telephone | 970-235-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 2519 S SHIELDS ST STE 1K
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City | FORT COLLINS
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State | CO
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Zip | 80526-1855
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Country | US
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Telephone | 970-235-1112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH CONNOR
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Credential | PMHNP
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Telephone | 720-445-1258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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