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General NPI Number Information
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NPI Number | 1215288915
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Entity Type | Organization
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Legal Business Name | C3, LLC
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 7546 VARDON WAY
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City | FORT COLLINS
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State | CO
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Zip | 80528-8845
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Country | US
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Telephone | 303-242-9484
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Fax |
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Provider Business Mailing Address
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Address Line | 7546 VARDON WAY
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City | FORT COLLINS
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State | CO
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Zip | 80528-8845
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Country | US
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Telephone | 303-242-9484
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF NURSING
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Name | MISS KELLY PAULINE KRIEGER
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Credential | DNP, FNP
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Telephone | 303-242-9484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number | NP-10086
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License Number State | CO
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