Provider Demographics
NPI:1871783738
Name:ORCUTT, SUSAN LEDANTEC (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEDANTEC
Last Name:ORCUTT
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:2700 GILSTRAP CT
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-8735
Mailing Address - Country:US
Mailing Address - Phone:970-945-2840
Mailing Address - Fax:970-945-2893
Practice Address - Street 1:1905 BLAKE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4288
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:970-945-2893
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2016-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO164864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72000252Medicaid
COCOAAA2414Medicare PIN
840742145OtherEIN