Basic Information
| Provider Information | |||||||||
| NPI: | 1871985952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 VINE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS ANIMAS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810541039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194562653 | ||||||||
| FaxNumber: | 7194560105 | ||||||||
| Practice Location | |||||||||
| Address1: | 30999 COUNTY ROAD 15 BLDG 5 | ||||||||
| Address2: | |||||||||
| City: | LAS ANIMAS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810549499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196621142 | ||||||||
| FaxNumber: | 7196621149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2015 | ||||||||
| LastUpdateDate: | 02/27/2018 | ||||||||
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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 | 0201279 | CO | Y | Nursing Service Providers | Registered Nurse |
No ID Information.