Basic Information
| Provider Information | |||||||||
| NPI: | 1588139273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACELROY | ||||||||
| FirstName: | JAIME | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 W DRAKE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704820198 | ||||||||
| FaxNumber: | 9704829148 | ||||||||
| Practice Location | |||||||||
| Address1: | 14631 COUNTY ROAD 10 | ||||||||
| Address2: | |||||||||
| City: | FORT LUPTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806218203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206352991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2018 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0994146 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.