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NPI Code Detail

MEDICARE: MS. ALICIA ODELL MIERS FNP

MEDICARE: MS. ALICIA ODELL MIERS FNP
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
1163W00000XRegistered NurseRN.0175434CO
2363LF0000XFamily Nurse PractitionerAPN.0992479-NPCO

General Provider Information

NPI Number : 1619421773
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALICIA ODELL MIERS FNP
Provider Business Mailing Address
First Line : 5450 WESTERN AVE
Second Line :
City : BOULDER
State : CO
Zip : 80301-2709
Country : US
Telephone Number : 303-415-4355
Fax Number : 303-415-4374
Provider Business Practice Location Address
First Line : 1000 W SOUTH BOULDER RD STE 110
Second Line :
City : LAFAYETTE
State : CO
Zip : 80026-2753
Country : US
Telephone Number : 303-415-4355
Fax Number : 303-666-1982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2016
Last Update Date : 02/27/2019

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