Individual
ROZELLA REBECCA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1024 S LEMAY AVE, FORT COLLINS, CO 80524-3929
(970) 495-7000
(303) 306-7753
Mailing address
PO BOX 912215, DENVER, CO 80291-2215
(303) 306-7101
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5221
GA
363A00000X
Physician Assistant
Primary
PA.0004163
CO
363A00000X
Physician Assistant
PA1380
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99487594
—
CO
Enumeration date
02/17/2007
Last updated
11/19/2015
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