Provider Demographics
NPI:1639666910
Name:RUS, NICOLETA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLETA
Middle Name:
Last Name:RUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NICOLETA
Other - Middle Name:
Other - Last Name:DUTCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4918 CARTER CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3804
Mailing Address - Country:US
Mailing Address - Phone:303-396-4142
Mailing Address - Fax:720-875-2877
Practice Address - Street 1:8401 S CHAMBERS RD # H101
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9498
Practice Address - Country:US
Practice Address - Phone:720-875-2880
Practice Address - Fax:720-875-2877
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-22
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0067045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine