Healthcare Provider Details

I. General information

NPI: 1891621116
Provider Name (Legal Business Name): NICOLE LEE COLCHISKI CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8386 S CUSTER LN
EVERGREEN CO
80439-6316
US

IV. Provider business mailing address

8386 S CUSTER LN
EVERGREEN CO
80439-6316
US

V. Phone/Fax

Practice location:
  • Phone: 720-785-3650
  • Fax:
Mailing address:
  • Phone: 720-785-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHAT.0006595
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: