Provider Demographics
NPI:1710761002
Name:WATERSTONE MEDICAL LLC
Entity Type:Organization
Organization Name:WATERSTONE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GORTON
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP
Authorized Official - Phone:970-492-5310
Mailing Address - Street 1:3015 WATERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6635
Mailing Address - Country:US
Mailing Address - Phone:970-492-5310
Mailing Address - Fax:
Practice Address - Street 1:3015 WATERSTONE CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6635
Practice Address - Country:US
Practice Address - Phone:970-492-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty