Provider Demographics
NPI:1912259664
Name:VAN DOVER, NANCY GAE (LIC ACUP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:GAE
Last Name:VAN DOVER
Suffix:
Gender:F
Credentials:LIC ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 COUNTY ROAD 250
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8937
Mailing Address - Country:US
Mailing Address - Phone:970-247-0719
Mailing Address - Fax:
Practice Address - Street 1:1540 COUNTY ROAD 250
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8937
Practice Address - Country:US
Practice Address - Phone:970-247-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist