Provider Demographics
NPI:1073212221
Name:FAUSER, ALIVIA ROSE (FNP)
Entity Type:Individual
Prefix:
First Name:ALIVIA
Middle Name:ROSE
Last Name:FAUSER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALIVIA
Other - Middle Name:ROSE
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:47 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2960
Mailing Address - Country:US
Mailing Address - Phone:719-352-8775
Mailing Address - Fax:
Practice Address - Street 1:47 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2960
Practice Address - Country:US
Practice Address - Phone:719-352-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1646136163WC0200X
COANP.0999512-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine