Provider Demographics
NPI:1073903464
Name:ASPEN GROVE FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:ASPEN GROVE FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:LEHR
Authorized Official - Suffix:
Authorized Official - Credentials:CNNP, FNP-C
Authorized Official - Phone:970-314-2805
Mailing Address - Street 1:3096 I-70 BUSINESS LOOP
Mailing Address - Street 2:UNIT D
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5774
Mailing Address - Country:US
Mailing Address - Phone:970-314-2805
Mailing Address - Fax:970-314-7919
Practice Address - Street 1:3096 I-70 BUSINESS LOOP
Practice Address - Street 2:UNIT D
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-5774
Practice Address - Country:US
Practice Address - Phone:970-314-2805
Practice Address - Fax:970-314-7919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0000492-NP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care