Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 281683 | CO |
NPI | 1639771298 |
---|---|
Provider Name | Mrs. Nickole Nieto |
First Address | Brighton, CO 80601-3636 |
Second Address | Brighton, CO 80601-3636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2020 |
Last Update Date | 09/11/2020 |