Provider Demographics
NPI:1801127717
Name:NELLOR, ANNA KAY (LAC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KAY
Last Name:NELLOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2106
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-2106
Mailing Address - Country:US
Mailing Address - Phone:970-672-6252
Mailing Address - Fax:
Practice Address - Street 1:4848 S COLLEGE AVE
Practice Address - Street 2:A-1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3770
Practice Address - Country:US
Practice Address - Phone:970-672-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1528171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist