Provider Demographics
NPI:1376511584
Name:DETTERER, SHARI L (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:L
Last Name:DETTERER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 COLLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-821-3031
Mailing Address - Fax:970-821-3525
Practice Address - Street 1:303 COLLAND DRIVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-821-3031
Practice Address - Fax:970-821-3525
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO78927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07789274Medicaid
800051Medicare ID - Type Unspecified
COCO307092Medicare PIN
COS74934Medicare UPIN
COP00339614Medicare PIN
COC805822Medicare PIN