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NPI Code Detail

MEDICARE: EVA JANELL MILAM NICHOLSON

MEDICARE: EVA JANELL MILAM NICHOLSON
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
1101YP2500XProfessional Counselor0015966CO

General Provider Information

NPI Number : 1730584269
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVA JANELL MILAM NICHOLSON
Provider Business Mailing Address
First Line : 320 W OLIVE ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80521-2716
Country : US
Telephone Number : 970-310-3406
Fax Number :
Provider Business Practice Location Address
First Line : 208 RACQUETTE DR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4851
Country : US
Telephone Number : 970-310-3406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2014
Last Update Date : 01/27/2020

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