Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 105311 | CO |
Y | 213EG0000X | General Practice | 105311 | CO |
NPI | 1003019589 |
---|---|
Provider Name | Dr. John Lindsay Nicolette |
First Address | Littleton, CO 80123-6767 |
Second Address | Englewood, CO 80113-3951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |