Healthcare Provider Details

I. General information

NPI: 1982508768
Provider Name (Legal Business Name): NICOLE IRENE PELLETIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 S PEARL ST APT 204
DENVER CO
80209-4234
US

IV. Provider business mailing address

969 S PEARL ST APT 204
DENVER CO
80209-4234
US

V. Phone/Fax

Practice location:
  • Phone: 720-968-7013
  • Fax:
Mailing address:
  • Phone: 720-968-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: