MEDICARE: ANNA KAY NELLOR L.AC.

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	171100000X	Acupuncturist	1528	CO

General Provider Information

NPI Number	:	1801127717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA KAY NELLOR L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 2106
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80522-2106
Country	:	US
Telephone Number	:	970-672-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	4848 S COLLEGE AVE
Second Line	:	A-1
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3770
Country	:	US
Telephone Number	:	970-672-6252
Fax Number	:

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

Provider Enumeration Date	:	01/18/2010
Last Update Date	:	01/12/2012

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