Provider Demographics
NPI:1831713312
Name:ECKERT, ANNA GRACE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:GRACE
Last Name:ECKERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E. ELIZABETH ST
Mailing Address - Street 2:UNIT G, SUITE 2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3037
Mailing Address - Country:US
Mailing Address - Phone:970-493-9193
Mailing Address - Fax:
Practice Address - Street 1:1120 E. ELIZABETH ST
Practice Address - Street 2:UNIT G, SUITE 2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-8052
Practice Address - Country:US
Practice Address - Phone:970-493-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COPA.0006905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program