MEDICARE: STACEY L O'HARA CRNP

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
1	363LA2100X	Acute Care Nurse Practitioner	SP008865	PA
2	363LA2100X	Acute Care Nurse Practitioner	APN.0991431-NP	CO

General Provider Information

NPI Number	:	1275788069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY L O'HARA CRNP

Provider Business Mailing Address
First Line	:	802 W DRAKE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:	970-494-6449
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 W DRAKE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:	970-494-6449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	01/04/2016

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