Healthcare Provider Details

I. General information

NPI: 1013753383
Provider Name (Legal Business Name): NICOLE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E 19TH AVE STE 200
DENVER CO
80218-1242
US

IV. Provider business mailing address

1721 E 19TH AVE STE 200
DENVER CO
80218-1242
US

V. Phone/Fax

Practice location:
  • Phone: 720-748-4800
  • Fax:
Mailing address:
  • Phone: 720-748-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number999808
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: