Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 38744 | CO |
NPI | 1851493936 |
---|---|
Provider Name | Dr. Nicolette Angelica Picerno |
First Address | Denver, CO 80210-5073 |
Second Address | Denver, CO 80210-5073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 27/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30057779 | (05) | CO |
38744 | STATE (01) | CO |
BP4630302 | DEA (01) | CO |
G69339 | (02) | CO |