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General NPI Number Information
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NPI Number | 1588510127
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Entity Type | Organization
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Legal Business Name | NORTHSTAR ONLINE CLINIC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 1508 HARVEST DR
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City | LAFAYETTE
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State | CO
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Zip | 80026-9434
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Country | US
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Telephone | 804-640-6030
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Fax | 720-405-4524
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Provider Business Mailing Address
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Address Line | 1508 HARVEST DR
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City | LAFAYETTE
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State | CO
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Zip | 80026-9434
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Country | US
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Telephone | 804-640-6030
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Fax | 720-405-4524
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | RYAN FOLEY
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Credential | NP
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Telephone | 804-640-6030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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