Provider Demographics
NPI:1710960380
Name:MALTZMAN, ALICIA E (NP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:E
Last Name:MALTZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-8850
Mailing Address - Fax:303-415-8870
Practice Address - Street 1:4800 RIVERBEND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2636
Practice Address - Country:US
Practice Address - Phone:303-415-8850
Practice Address - Fax:303-415-8870
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0003689-NP363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82924767Medicaid
CO82924767Medicaid
COP00000562Medicare PIN
COC493738Medicare PIN