Healthcare Provider Details

I. General information

NPI: 1336505031
Provider Name (Legal Business Name): NICOLAS NELSON C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E 13TH ST STE 210
LOVELAND CO
80537-5136
US

IV. Provider business mailing address

3702 S TIMBERLINE RD STE A
FORT COLLINS CO
80525-3625
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-5432
  • Fax:
Mailing address:
  • Phone: 970-207-9773
  • Fax: 970-207-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number112179
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP145291
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: