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NPI Code Detail

MEDICARE: JEANINE LABAW PMHNP-BC, PSYD

MEDICARE: JEANINE LABAW PMHNP-BC, PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY.0000790CO
2163W00000XRegistered NurseRN.0045886CO
3364S00000XClinical Nurse SpecialistAPN.0000326-CNSCO
4363LP0808XPsychiatric/Mental Health Nurse PractitionerAPN.0990892-NPCO

General Provider Information

NPI Number : 1043225444
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANINE LABAW PMHNP-BC, PSYD
Provider Business Mailing Address
First Line : 4856 INNOVATION DR STE B
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-5540
Country : US
Telephone Number : 970-494-4200
Fax Number :
Provider Business Practice Location Address
First Line : 1250 N WILSON AVE
Second Line :
City : LOVELAND
State : CO
Zip : 80537-4461
Country : US
Telephone Number : 970-494-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 05/30/2019

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