Provider Demographics
NPI:1194436451
Name:LAURIE F NILES, DNP, PLLC
Entity type:Organization
Organization Name:LAURIE F NILES, DNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-980-8685
Mailing Address - Street 1:5757 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6911
Mailing Address - Country:US
Mailing Address - Phone:970-980-8685
Mailing Address - Fax:970-233-4560
Practice Address - Street 1:5757 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6911
Practice Address - Country:US
Practice Address - Phone:970-980-8685
Practice Address - Fax:970-233-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center