Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP-71 | CO |
NPI | 1043515240 |
---|---|
Provider Name | Madeline Louise Nichols |
First Address | Lakewood, CO 80214-5728 |
Second Address | Lakewood, CO 80214-5728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2011 |
Last Update Date | 19/01/2011 |