Organization
PRAIRIE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TENNILLE ANN RAU FNP-C (LLC MEMBER/MEDICAL PROVIDER)
(719) 691-4642
Entity
Organization
Contact information
Practice address
172 WEST 1ST, SPRINGFIELD, CO 81073-8107
(719) 691-4488
Mailing address
172 WEST 1ST, SPRINGFIELD, CO 81073-9716
(719) 691-4488
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114384138
NPI 1
CO
Enumeration date
12/22/2022
Last updated
06/20/2025
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