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General NPI Number Information
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NPI Number | 1912638057
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Entity Type | Organization
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Legal Business Name | HIGH COUNTRY INFUSION & WELLNESS CENTER
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 409 MAIN ST # 216
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City | FRISCO
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State | CO
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Zip | 80443-5929
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Country | US
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Telephone | 970-485-4573
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Fax | 970-406-5086
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Provider Business Mailing Address
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Address Line | 1685 S COLORADO BLVD UNIT S108
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City | DENVER
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State | CO
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Zip | 80222-4000
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Country | US
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Telephone | 970-485-4573
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Fax | 970-406-5086
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Authorized Official
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Title or Position | OWNER
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Name | MANDY GLASMEYER
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Credential | CRNA
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Telephone | 970-485-4573
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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