Healthcare Provider Details

I. General information

NPI: 1841874591
Provider Name (Legal Business Name): NICO DAVID BOHM PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S CHERRY ST FL 10
DENVER CO
80246-1226
US

IV. Provider business mailing address

425 S CHERRY ST FL 10
DENVER CO
80246-1226
US

V. Phone/Fax

Practice location:
  • Phone: 720-712-0306
  • Fax:
Mailing address:
  • Phone: 720-712-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996495-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: