Provider Demographics
NPI:1639372121
Name:PELLMAN, NANCY THERESA (RN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:THERESA
Last Name:PELLMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NAPA VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-266-9471
Mailing Address - Fax:970-266-9551
Practice Address - Street 1:COLORADO STATE UNIVERSITY
Practice Address - Street 2:HARTSHORNE HEALTH SERVICES
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523
Practice Address - Country:US
Practice Address - Phone:970-491-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO130698163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse