Provider Demographics
NPI:1740743715
Name:STEFANKO, NICOLE S (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:S
Last Name:STEFANKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 S TIMBERLINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4332
Mailing Address - Country:US
Mailing Address - Phone:970-221-5795
Mailing Address - Fax:
Practice Address - Street 1:3726 S TIMBERLINE RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4332
Practice Address - Country:US
Practice Address - Phone:970-221-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0070457207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology