Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APN.0994912-NP | CO |
NPI | 1184277816 |
---|---|
Provider Name | Mrs. Nichole Christiana Larez |
First Address | Brighton, CO 80601-6603 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2019 |
Last Update Date | 07/09/2021 |