MEDICARE: C3, LLC

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	363LC1500X	Community Health Nurse Practitioner	NP-10086	CO

General Provider Information

NPI Number	:	1215288915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C3, LLC

Provider Business Mailing Address
First Line	:	7546 VARDON WAY
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8845
Country	:	US
Telephone Number	:	303-242-9484
Fax Number	:

Provider Business Practice Location Address
First Line	:	7546 VARDON WAY
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8845
Country	:	US
Telephone Number	:	303-242-9484
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF NURSING
Name	:	MISS KELLY PAULINE KRIEGER
Credential	:	DNP, FNP
Telephone Number	:	303-242-9484

Provider Enumeration Date	:	09/21/2012
Last Update Date	:	09/21/2012

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