Healthcare Provider Details

I. General information

NPI: 1851493936
Provider Name (Legal Business Name): NICOLETTE ANGELICA PICERNO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE STE 505
DENVER CO
80210-5078
US

IV. Provider business mailing address

850 E HARVARD AVE STE #505
DENVER CO
80210-5073
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-1961
  • Fax: 303-744-1110
Mailing address:
  • Phone: 303-744-1961
  • Fax: 303-744-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number38744
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: