=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508784315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICAH ROTEN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2026
-----------------------------------------------------
Last Update Date | 07/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 362 W FIRST ST
-----------------------------------------------------
City | PALISADE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81526-8781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-210-0923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 362 W FIRST ST
-----------------------------------------------------
City | PALISADE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81526-8781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WA2000X
-----------------------------------------------------
Taxonomy Name | Administrator Registered Nurse
-----------------------------------------------------
License Number | 150158
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------