MEDICARE: ANNA GRACE ECKERT

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	PA.0006905	CO

General Provider Information

NPI Number	:	1831713312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA GRACE ECKERT

Provider Business Mailing Address
First Line	:	1120 E. ELIZABETH ST
Second Line	:	UNIT G, SUITE 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3037
Country	:	US
Telephone Number	:	970-493-9193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 E. ELIZABETH ST
Second Line	:	UNIT G, SUITE 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-8052
Country	:	US
Telephone Number	:	970-493-9193
Fax Number	:

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

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	11/02/2021

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Directions to “ ANNA GRACE ECKERT ” Practice Location

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