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General NPI Number Information
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NPI Number | 1548149180
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Entity Type | Individual
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Provider Name | CARLY ANN MICEK
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Gender | Female
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 2525 15TH ST
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City | DENVER
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State | CO
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Zip | 80211-3989
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Country | US
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Telephone | 859-779-0419
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Fax |
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Provider Business Mailing Address
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Address Line | 9373 MORNING GLORY LN
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80130-4494
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | QSSS85IEQY
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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