Provider Demographics
NPI:1730115452
Name:BORTHWICK, LAURIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:BORTHWICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2554
Mailing Address - Country:US
Mailing Address - Phone:970-266-1683
Mailing Address - Fax:970-491-0226
Practice Address - Street 1:600 SOUTH DRIVE
Practice Address - Street 2:COLORADO STATE UNIVERSITY HEALTH CENTER
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-1754
Practice Address - Fax:970-491-0226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily