MEDICARE: NICOLE LYNN STALTER ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AO92663	IA
2	363LF0000X	Family Nurse Practitioner	SNP 100095	CO
3	363L00000X	Nurse Practitioner	AP-N0990646-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265449128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LYNN STALTER ARNP

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-442-2615
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 BLAKE AVE
Second Line	:	SUITE 101
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4288
Country	:	US
Telephone Number	:	970-945-2840
Fax Number	:	970-945-2893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	02/11/2026

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