Basic Information
| Provider Information | |||||||||
| NPI: | 1619421773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIERS | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | ODELL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5450 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803012709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154355 | ||||||||
| FaxNumber: | 3034154374 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W SOUTH BOULDER RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800262753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034154355 | ||||||||
| FaxNumber: | 3036661982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2016 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.0175434 | CO | N | Nursing Service Providers | Registered Nurse | 363LF0000X | APN.0992479-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.