Individual
REBECCA SUZANNE BOHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1120 E ELIZABETH ST STE F101, FORT COLLINS, CO 80524-4044
(970) 584-1063
(970) 584-1055
Mailing address
203 S ROLLIE AVE, FORT LUPTON, CO 80621-1508
(303) 286-4560
(303) 286-4589
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
COA109658
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17123313
—
CO
Enumeration date
10/03/2012
Last updated
05/02/2022
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