Canon Professional Wellness Clinic LLC
NPI 1780384560ActiveOrganization· Nurse Practitioner, Primary Care· Canon City, CO
Nurse Practitioner, Primary Care in Canon City, Colorado, registered in NPPES in March 2023. The authorized official on file is Leslie Nelson, APN, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1780384560 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 9, 2023 |
| Last updated in NPPES | Feb 19, 2024 |
| Certified by provider | Feb 19, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Primary Care Primary | 363LP2300X | — | — |
| Clinic/Center, Family Planning, Non-Surgical | 261QF0050X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (CO) |
|---|