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General NPI Number Information
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NPI Number | 1790320901
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Entity Type | Organization
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Legal Business Name | COUNTY OF LARIMER
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 200 PERIDOT ST
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City | LOVELAND
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State | CO
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Zip | 80537-5198
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Country | US
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Telephone | 970-619-4580
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 BLUE SPRUCE DR
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City | FORT COLLINS
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State | CO
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Zip | 80524-2004
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Country | US
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Telephone | 970-498-6719
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CHRISTINE ROSE NEVIN-WOODS
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Credential | DO
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Telephone | 970-498-6719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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