Provider Demographics
NPI:1366854713
Name:HART, VICKI (NP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY
Mailing Address - Street 2:SUITE210
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-655-3000
Mailing Address - Fax:303-655-3001
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY
Practice Address - Street 2:SUITE210
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-655-3000
Practice Address - Fax:303-655-3001
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0049319363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCA6308Medicare UPIN