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General NPI Number Information
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NPI Number | 1568978229
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Entity Type | Organization
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Legal Business Name | MEDPHONE RX LLC
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 219 W MAGNOLIA ST
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City | FORT COLLINS
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State | CO
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Zip | 80521-2926
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Country | US
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Telephone | 970-617-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 1894 SEVEN LAKES DR
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City | LOVELAND
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State | CO
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Zip | 80538-4841
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Country | US
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Telephone | 720-771-6292
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Fax |
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Authorized Official
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Title or Position | FNP-BC, OWNER
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Name | EVELYN BARDAGO HU
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Credential | MSN, NP-C
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Telephone | 970-646-2153
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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 | 0990763
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License Number State | CO
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