Healthcare Provider Details

I. General information

NPI: 1588139273
Provider Name (Legal Business Name): JAIME MACELROY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14631 COUNTY ROAD 10
FORT LUPTON CO
80621-8203
US

IV. Provider business mailing address

802 W DRAKE RD STE 101
FORT COLLINS CO
80526-5567
US

V. Phone/Fax

Practice location:
  • Phone: 720-635-2991
  • Fax:
Mailing address:
  • Phone: 970-482-0198
  • Fax: 970-482-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0994146
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: