=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437738184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHANIEL FORTNER LEE DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2021
-----------------------------------------------------
Last Update Date | 07/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16222 W US HIGHWAY 24 STE 200
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80863-8763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-686-0878
-----------------------------------------------------
Fax | 719-365-7885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-624-4123
-----------------------------------------------------
Fax | 970-490-4173
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 177916
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DR.0073803
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------