Provider Demographics
NPI:1922314764
Name:CSU STUDENT HEALTH
Entity Type:Organization
Organization Name:CSU STUDENT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-491-7121
Mailing Address - Street 1:305 POUDRE BAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6109
Mailing Address - Country:US
Mailing Address - Phone:970-686-6748
Mailing Address - Fax:
Practice Address - Street 1:600 SOUTH DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-114168261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center