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General NPI Number Information
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NPI Number | 1699545046
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Entity Type | Individual
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Provider Name | NICOLE NILES RDH
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Gender | Female
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 1325 HOVER ST STE 201
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City | LONGMONT
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State | CO
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Zip | 80501-3176
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Country | US
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Telephone | 303-848-8373
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Fax |
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Provider Business Mailing Address
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Address Line | 208 W 52ND ST
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City | LOVELAND
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State | CO
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Zip | 80538-1612
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2026537
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License Number State | CO
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