Provider Demographics
NPI:1225411242
Name:STOCKWELL, NICHOLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:STOCKWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4563
Mailing Address - Country:US
Mailing Address - Phone:970-522-2264
Mailing Address - Fax:
Practice Address - Street 1:4350 LIMELIGHT AVE STE 100
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8034
Practice Address - Country:US
Practice Address - Phone:720-455-3775
Practice Address - Fax:720-455-3776
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM2763399-153207X00000X
CODR.0066034207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery