MEDICARE: DR. NICOLE S STEFANKO MD

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	207N00000X	Dermatology Physician	DR.0070457	CO

General Provider Information

NPI Number	:	1740743715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE S STEFANKO MD

Provider Business Mailing Address
First Line	:	3726 S TIMBERLINE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4332
Country	:	US
Telephone Number	:	970-221-5795
Fax Number	:

Provider Business Practice Location Address
First Line	:	3726 S TIMBERLINE RD STE 101
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4332
Country	:	US
Telephone Number	:	970-221-5795
Fax Number	:

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

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	10/13/2023

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