Provider Demographics
NPI:1407121544
Name:KLEIN, NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 AUSTIN BLUFFS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5701
Mailing Address - Country:US
Mailing Address - Phone:719-265-4412
Mailing Address - Fax:719-888-1739
Practice Address - Street 1:3425 AUSTIN BLUFFS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5701
Practice Address - Country:US
Practice Address - Phone:719-265-4412
Practice Address - Fax:719-888-1739
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990350363LA2200X
CONP-990350363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39512509Medicaid