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General NPI Number Information
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NPI Number | 1558512558
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Entity Type | Individual
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Provider Name | LARA KATHLEEN WIGINTON-MCCORMICK CNM
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Gender | Female
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 1025 PENNOCK PL
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City | FORT COLLINS
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State | CO
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Zip | 80524-3257
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Country | US
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Telephone | 970-495-8800
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Fax | 970-495-8820
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Provider Business Mailing Address
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Address Line | 1025 PENNOCK PL
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City | FORT COLLINS
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State | CO
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Zip | 80524-3257
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Country | US
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Telephone | 970-495-8800
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Fax | 970-495-8820
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 990222
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 190225
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | APN.0006038-CNM
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License Number State | CO
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