Provider Demographics
NPI:1699023176
Name:PROCHAZKA, NICOLE JEAN (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEAN
Last Name:PROCHAZKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 N MANILA RD
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-9585
Mailing Address - Country:US
Mailing Address - Phone:303-827-8081
Mailing Address - Fax:
Practice Address - Street 1:9280 N MANILA RD
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-9585
Practice Address - Country:US
Practice Address - Phone:303-827-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0188862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse