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General NPI Number Information
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NPI Number | 1972468098
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Entity Type | Individual
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Provider Name | NICOLLETTE WALES PA-S
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Gender | Female
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Dates
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Enumeration Date | 12/20/2025
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Last Update Date | 12/20/2025
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Provider Practice Location Address
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Address Line | 10200 PARK MEADOWS DR UNIT 732
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City | LONE TREE
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State | CO
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Zip | 80124-5461
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Country | US
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Telephone | 801-419-7308
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Fax |
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Provider Business Mailing Address
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Address Line | 10200 PARK MEADOWS DR UNIT 732
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City | LONE TREE
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State | CO
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Zip | 80124-5461
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Country | US
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Telephone | 801-419-7308
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | STUDENT
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License Number State | CO
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