Healthcare Provider Details

I. General information

NPI: 1528993185
Provider Name (Legal Business Name): NICOLE GLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 DELAWARE ST
DENVER CO
80204-4532
US

IV. Provider business mailing address

20054 SUMMERSET CT
PARKER CO
80138-3831
US

V. Phone/Fax

Practice location:
  • Phone: 720-461-0015
  • Fax:
Mailing address:
  • Phone: 720-461-0015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN.1690826
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: