MEDICARE: JANE NESVOG ATC

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	2255A2300X	Athletic Trainer	0002795	CO

General Provider Information

NPI Number	:	1073479689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE NESVOG ATC

Provider Business Mailing Address
First Line	:	2914 GOLDEN HARVEST LN
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3137
Country	:	US
Telephone Number	:	970-222-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	2914 GOLDEN HARVEST LN
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3137
Country	:	US
Telephone Number	:	970-222-1011
Fax Number	:

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

Provider Enumeration Date	:	12/27/2025
Last Update Date	:	12/27/2025

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