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NPI Code Detail

MEDICARE: MEGAN LEAH HERZOG GNP

MEDICARE: MEGAN LEAH HERZOG GNP
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
1363LP2300XPrimary Care Nurse Practitioner0995065-NPCO
2363LG0600XGerontology Nurse PractitionerR1675081MN

General Provider Information

NPI Number : 1538376389
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN LEAH HERZOG GNP
Provider Business Mailing Address
First Line : 4211 ZODIAC PL
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80109-3769
Country : US
Telephone Number : 952-288-5920
Fax Number :
Provider Business Practice Location Address
First Line : 12600 W COLFAX AVE STE B200
Second Line :
City : LAKEWOOD
State : CO
Zip : 80215-3736
Country : US
Telephone Number : 303-459-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 11/10/2023

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