Randazzo, Connie Mallo

Randazzo, Connie Mallo is an individual health care provider with primary practice located at 2620 E Prospect Rd Suite 190, Fort Collins CO 80525-9098. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Randazzo, Connie Mallo can be contacted via phone (970) 221-1106.

Contact Information

Primary practice address
2620 E Prospect Rd Suite 190 Fort Collins CO 80525-9098
Phone: (970) 221-1106
Fax: (970) 232-1050
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 364SP0808X 81170 Colorado

Profile Details

NPI number 1871602664
LBN Legal business name Randazzo, Connie Mallo
Credentials Clinical Nurse Specialist (CNS)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 29th, 2006
Last updated May 26th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871602664 NPPES
Colorado MEDICAID 87954770

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