MEDICARE: AIMEE NICKEL

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	390200000X	Student in an Organized Health Care Education/Training Program	RBT-15-08582	CO

General Provider Information

NPI Number	:	1679933352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE NICKEL

Provider Business Mailing Address
First Line	:	1312 17TH ST
Second Line	:	SUITE 146
City	:	DENVER
State	:	CO
Zip	:	80202-1508
Country	:	US
Telephone Number	:	303-997-0305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 17TH ST
Second Line	:	SUITE 146
City	:	DENVER
State	:	CO
Zip	:	80202-1508
Country	:	US
Telephone Number	:	303-997-0305
Fax Number	:

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

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	02/24/2016

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Directions to “ AIMEE NICKEL ” Practice Location

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