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General NPI Number Information
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NPI Number | 1659165017
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Entity Type | Individual
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Provider Name | BRAD MATTHEW HERTZOG
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Gender | Male
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 21825 E QUINCY AVE
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City | AURORA
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State | CO
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Zip | 80018-3155
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Country | US
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Telephone | 970-988-0838
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Fax |
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Provider Business Mailing Address
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Address Line | 21825 E QUINCY AVE
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City | AURORA
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State | CO
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Zip | 80018-3155
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Country | US
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Telephone | 970-988-0838
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 57166
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN.1639037
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License Number State | CO
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