Individual
MS. CAROL FOX GOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
303 COLLAND DR, FORT COLLINS, CO 80525-4205
(970) 461-8031
(970) 461-8932
Mailing address
1627 E 18TH ST, LOVELAND, CO 80538-4209
(970) 663-0135
(970) 461-1422
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
70182
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37526545
—
CO
Enumeration date
07/12/2006
Last updated
06/02/2011
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