Provider Demographics
NPI:1538376389
Name:HERZOG, MEGAN LEAH (GNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEAH
Last Name:HERZOG
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 ZODIAC PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3769
Mailing Address - Country:US
Mailing Address - Phone:952-288-5920
Mailing Address - Fax:
Practice Address - Street 1:12600 W COLFAX AVE STE B200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3736
Practice Address - Country:US
Practice Address - Phone:303-459-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0995065-NP363LP2300X
MNR1675081363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology