Healthcare Provider Details

I. General information

NPI: 1548788367
Provider Name (Legal Business Name): NICOLE CRYSTAL CESSFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3354 S FLOWER ST APT 37
LAKEWOOD CO
80227-4660
US

IV. Provider business mailing address

3354 S FLOWER ST APT 37
LAKEWOOD CO
80227-4660
US

V. Phone/Fax

Practice location:
  • Phone: 303-681-4557
  • Fax:
Mailing address:
  • Phone: 303-681-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number0187695
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: