Provider Demographics
NPI:1548788367
Name:CESSFORD, NICOLE CRYSTAL
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CRYSTAL
Last Name:CESSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 S FLOWER ST APT 37
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4660
Mailing Address - Country:US
Mailing Address - Phone:303-681-4557
Mailing Address - Fax:
Practice Address - Street 1:3354 S FLOWER ST APT 37
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4660
Practice Address - Country:US
Practice Address - Phone:303-681-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0187695163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care