MEDICARE: MRS. HEATHER R WATTERS FNP-C

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	363LF0000X	Family Nurse Practitioner	0995097	CO

General Provider Information

NPI Number	:	1467094581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER R WATTERS FNP-C

Provider Business Mailing Address
First Line	:	2580 E HARMONY RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-9631
Country	:	US
Telephone Number	:	303-929-4875
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 E HARMONY RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-9631
Country	:	US
Telephone Number	:	303-929-4875
Fax Number	:

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

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	09/12/2024

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