Individual
NICOLE MARIE HANNON ROBERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1107 S LEMAY AVENUE, SUITE 300, FORT COLLINS, CO 80524-3955
(970) 493-7442
(970) 493-7442
Mailing address
1107 S LEMAY AVENUE, SUITE 300, FORT COLLINS, CO 80524-3955
(970) 493-7442
(970) 493-7442
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
47447
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000372082
ANTHEM PROVIDER NUMBER
IN
01
—
11485755
CAQH NUMBER
IN
05
—
200528800
—
IN
01
—
9397429
PHCS PID NUMBER
IN
Enumeration date
03/15/2006
Last updated
03/10/2020
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