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NPI Code Detail

MEDICARE: NICHOL LEE WIDGA BA

MEDICARE: NICHOL LEE WIDGA BA
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1730326810
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOL LEE WIDGA BA
Provider Business Mailing Address
First Line : 4141 E DICKENSON PL
Second Line :
City : DENVER
State : CO
Zip : 80222-6012
Country : US
Telephone Number : 303-504-6509
Fax Number : 303-782-0916
Provider Business Practice Location Address
First Line : 2829 W 33RD AVE
Second Line :
City : DENVER
State : CO
Zip : 80211-3231
Country : US
Telephone Number : 303-433-3944
Fax Number : 303-433-9717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2009
Last Update Date : 01/12/2009

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