Provider Demographics
NPI:1568978229
Name:MEDPHONE RX LLC
Entity Type:Organization
Organization Name:MEDPHONE RX LLC
Other - Org Name:MEDPHONE RX LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP-BC, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:BARDAGO
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, NP-C
Authorized Official - Phone:970-646-2153
Mailing Address - Street 1:1894 SEVEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4841
Mailing Address - Country:US
Mailing Address - Phone:720-771-6292
Mailing Address - Fax:
Practice Address - Street 1:219 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2926
Practice Address - Country:US
Practice Address - Phone:970-617-3132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty