MEDICARE: GLOW WELLNESS AND WEIGHT LOSS LIMITED

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	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1447047022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOW WELLNESS AND WEIGHT LOSS LIMITED

Provider Business Mailing Address
First Line	:	1136 E STUART ST STE 4202
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1193
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1136 E STUART ST STE 4202
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1193
Country	:	US
Telephone Number	:	970-690-3309
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHANIE MARTIN
Credential	:
Telephone Number	:	970-690-3309

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	07/17/2025

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Directions to “GLOW WELLNESS AND WEIGHT LOSS LIMITED ” Practice Location

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