Provider Demographics
NPI:1871985952
Name:STEPHENS, NICOLE (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 VINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054-1039
Mailing Address - Country:US
Mailing Address - Phone:719-456-2653
Mailing Address - Fax:719-456-0105
Practice Address - Street 1:30999 COUNTY ROAD 15 BLDG 5
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-9499
Practice Address - Country:US
Practice Address - Phone:719-662-1142
Practice Address - Fax:719-662-1149
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0201279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse