Provider Demographics
NPI:1043515240
Name:NICHOLS, MADELINE LOUISE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:LOUISE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5728
Mailing Address - Country:US
Mailing Address - Phone:303-233-8701
Mailing Address - Fax:303-233-2850
Practice Address - Street 1:2020 WADSWORTH BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5728
Practice Address - Country:US
Practice Address - Phone:303-233-8701
Practice Address - Fax:303-233-2850
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-71363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics