Provider Demographics
NPI:1578552436
Name:FANNING SCHUBERT, MONICA L (MSN/NP)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:L
Last Name:FANNING SCHUBERT
Suffix:
Gender:F
Credentials:MSN/NP
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:FANNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, APRN-BC
Mailing Address - Street 1:9195 GRANT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4385
Mailing Address - Country:US
Mailing Address - Phone:303-292-0034
Mailing Address - Fax:303-292-0097
Practice Address - Street 1:9025 GRANT ST STE 200
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4347
Practice Address - Country:US
Practice Address - Phone:303-292-0034
Practice Address - Fax:303-292-0097
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO100617363L00000X
CO3544-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO448798Medicare ID - Type Unspecified
COP44085Medicare UPIN