OrganizationActive
Canon Professional Wellness Clinic LLC
NPI 1780384560 · Primary Care Nurse Practitioner · Canon City, CO
Provider details
- NPI number
- 1780384560
- Entity type
- Organization
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Leslie Nelson, Owner(719) 285-5019
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Ambulatory Health Care Facilities
Practice location
730 Macon Ave
Canon City, CO 81212-3314
Phone: (719) 275-1618
Approximate (ZIP-level) locationGet directions
Mailing address
730 Macon Ave
Canon City, CO 81212-3314
Registry dates
- Enumerated
- 2023-03-09
- Last updated
- 2024-02-19
- Certified
- 2024-02-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.