Provider Demographics
NPI:1720541170
Name:SLOAN, CHARLES PORTER III (NP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PORTER
Last Name:SLOAN
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4672 W 20TH STREET RD UNIT 2011
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8401
Mailing Address - Country:US
Mailing Address - Phone:970-402-3330
Mailing Address - Fax:
Practice Address - Street 1:2101 KEN PRATT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6568
Practice Address - Country:US
Practice Address - Phone:303-649-3500
Practice Address - Fax:303-649-3501
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0199010364S00000X
CORXN.0103920-CNS364S00000X
COAPN.0996481-NP363L00000X
CORXN.0105559-NP363L00000X
COAPN.0994548-CNS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist