MEDICARE: NEELOFER BAIG CLARK L AC RN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	164885	CO
2	171100000X	Acupuncturist	1443	CO
3	363LF0000X	Family Nurse Practitioner	APN.0998347	CO

General Provider Information

NPI Number	:	1811240021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEELOFER BAIG CLARK L AC RN, FNP-C

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 150
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:	970-970-2421
Fax Number	:	970-490-4156

Provider Business Practice Location Address
First Line	:	1025 PENNOCK PL STE 121
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3250
Country	:	US
Telephone Number	:	970-495-8980
Fax Number	:	970-495-8988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	01/31/2023

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