Healthcare Provider Details

I. General information

NPI: 1750835260
Provider Name (Legal Business Name): NICHOLE VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 6TH ST
WELLINGTON CO
80549-1516
US

IV. Provider business mailing address

7901 6TH ST
WELLINGTON CO
80549-1516
US

V. Phone/Fax

Practice location:
  • Phone: 970-568-0030
  • Fax:
Mailing address:
  • Phone: 970-568-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number905715
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: