MEDICARE: DANA I MCANINCH NP

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	APN.0991136-NP	CO
2	363LG0600X	Gerontology Nurse Practitioner	AG0613044	CO
3	363L00000X	Nurse Practitioner	APN.0991136-NP	CO

General Provider Information

NPI Number	:	1548698400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA I MCANINCH NP

Provider Business Mailing Address
First Line	:	802 W DRAKE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:	970-482-0198
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 W DRAKE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:	970-482-0198
Fax Number	:

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

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	11/06/2015

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