Provider Demographics
NPI:1962954172
Name:REARDON, MARGARET EILEEN (APRN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:EILEEN
Last Name:REARDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15848 LONGMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3707
Mailing Address - Country:US
Mailing Address - Phone:913-526-9094
Mailing Address - Fax:
Practice Address - Street 1:1230 TENDERFOOT HILL RD STE 255
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-7393
Practice Address - Country:US
Practice Address - Phone:719-694-9446
Practice Address - Fax:720-694-9436
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0002728-C-NP225000000X, 363LA2100X, 363LF0000X, 363L00000X
TXAP132473363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty