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NPI Code Detail

MEDICARE: MARY LAUDERDALE

MEDICARE: MARY LAUDERDALE
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
1163W00000XRegistered Nurse117108CO

General Provider Information

NPI Number : 1780044917
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LAUDERDALE
Provider Business Mailing Address
First Line : 1313 RIVERSIDE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4352
Country : US
Telephone Number : 970-493-1292
Fax Number : 970-493-1210
Provider Business Practice Location Address
First Line : 1313 RIVERSIDE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4352
Country : US
Telephone Number : 970-493-1292
Fax Number : 970-493-1210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2016
Last Update Date : 03/01/2016

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Directions to “ MARY LAUDERDALE ” Practice Location

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