Provider Demographics
NPI:1710147848
Name:HUNTRESS, NICOLE KRISTEN (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTEN
Last Name:HUNTRESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:KRISTEN
Other - Last Name:GRADISEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 911244
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1244
Mailing Address - Country:US
Mailing Address - Phone:888-269-7001
Mailing Address - Fax:303-764-6640
Practice Address - Street 1:6069 S SOUTHLANDS PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016
Practice Address - Country:US
Practice Address - Phone:303-928-7555
Practice Address - Fax:303-928-7560
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00518282080S0010X
SCLL30973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics