Provider Demographics
NPI:1184669343
Name:HORSTMANN, NANCY MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MARY
Last Name:HORSTMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4141 ARAPAHOE AVE
Mailing Address - Street 2:#205
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1032
Mailing Address - Country:US
Mailing Address - Phone:303-447-0811
Mailing Address - Fax:303-442-3170
Practice Address - Street 1:4141 ARAPAHOE AVE
Practice Address - Street 2:#205
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1032
Practice Address - Country:US
Practice Address - Phone:303-447-0811
Practice Address - Fax:303-442-3170
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC60766Medicaid