Healthcare Provider Details

I. General information

NPI: 1104242585
Provider Name (Legal Business Name): NICOLE K CHASNOW PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 HALE PKWY STE 360
DENVER CO
80220-4041
US

IV. Provider business mailing address

1601 E 19TH AVE STE 6250
DENVER CO
80218-1291
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-1333
  • Fax: 303-321-0620
Mailing address:
  • Phone: 303-762-3472
  • Fax: 303-861-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0003885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: