Healthcare Provider Details

I. General information

NPI: 1689701211
Provider Name (Legal Business Name): DAVID ALBERT NICHOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BLUFF ST
BOULDER CO
80304-4287
US

IV. Provider business mailing address

1900 BLUFF ST
BOULDER CO
80304-4287
US

V. Phone/Fax

Practice location:
  • Phone: 720-381-6090
  • Fax:
Mailing address:
  • Phone: 303-877-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number45536
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number45536
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: