Provider Demographics
NPI:1245762343
Name:HAPPY DAISY LTD
Entity Type:Organization
Organization Name:HAPPY DAISY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:
Authorized Official - First Name:TENLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:970-833-1280
Mailing Address - Street 1:1136 E STUART ST STE 4101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1173
Mailing Address - Country:US
Mailing Address - Phone:970-833-1280
Mailing Address - Fax:
Practice Address - Street 1:1136 E STUART ST STE 4101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1173
Practice Address - Country:US
Practice Address - Phone:970-833-1280
Practice Address - Fax:949-437-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10022363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty