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General NPI Number Information
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NPI Number | 1619421773
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Entity Type | Individual
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Provider Name | ALICIA ODELL MIERS FNP
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Gender | Female
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 1000 W SOUTH BOULDER RD STE 110
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City | LAFAYETTE
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State | CO
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Zip | 80026-2753
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Country | US
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Telephone | 303-415-4355
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Fax | 303-666-1982
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Provider Business Mailing Address
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Address Line | 5450 WESTERN AVE
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City | BOULDER
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State | CO
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Zip | 80301-2709
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Country | US
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Telephone | 303-415-4355
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Fax | 303-415-4374
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.0175434
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0992479-NP
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License Number State | CO
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