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General NPI Number Information
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NPI Number | 1518846179
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Entity Type | Individual
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Provider Name | AVERY LEE MALTZAHN
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Gender | Female
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 3726 S TIMBERLINE RD STE 102
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City | FORT COLLINS
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State | CO
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Zip | 80525-4332
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Country | US
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Telephone | 970-690-5938
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Fax |
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Provider Business Mailing Address
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Address Line | 3715 COPPER SPRING DR
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City | FORT COLLINS
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State | CO
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Zip | 80528-4530
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Country | US
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Telephone | 970-690-5938
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | COZ.0712238
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License Number State | CO
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