Organization
CANON PROFESSIONAL WELLNESS CLINIC LLC
Active
Organization
CANON PROFESSIONAL WELLNESS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE NELSON APN (OWNER)
(719) 285-5019
Entity
Organization
Contact information
Practice address
730 MACON AVE, CANON CITY, CO 81212-3314
(719) 275-1618
Mailing address
730 MACON AVE, CANON CITY, CO 81212-3314
(719) 275-1618
Taxonomy
Speciality
Code
Description
License number
State
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/09/2023
Last updated
02/19/2024
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