Provider Demographics
NPI:1336505031
Name:NELSON, NICOLAS (CRNA)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 S TIMBERLINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3625
Mailing Address - Country:US
Mailing Address - Phone:970-207-9773
Mailing Address - Fax:970-207-1893
Practice Address - Street 1:2555 E 13TH ST STE 210
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5136
Practice Address - Country:US
Practice Address - Phone:970-669-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK112179367500000X
TXAP145291367500000X
CO0001185367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8MQ123OtherBCBS
TX4221442001Medicaid