Provider Demographics
NPI:1861713075
Name:DETERS, JULIE M (FNP)
Entity type:Individual
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First Name:JULIE
Middle Name:M
Last Name:DETERS
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:3702 S TIMBERLINE RD
Mailing Address - Street 2:BLDG A
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3624
Mailing Address - Country:US
Mailing Address - Phone:970-207-9773
Mailing Address - Fax:970-207-1893
Practice Address - Street 1:2555 E 13TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5133
Practice Address - Country:US
Practice Address - Phone:970-669-5432
Practice Address - Fax:970-461-6275
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2014-12-03
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Provider Licenses
StateLicense IDTaxonomies
CONP-10339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC452568Medicare Oscar/Certification
COC452568Medicare Oscar/Certification