Provider Demographics
NPI:1841615325
Name:JANZEN, NICOLE (LMT, ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JANZEN
Suffix:
Gender:F
Credentials:LMT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 CHURCH RANCH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5547
Mailing Address - Country:US
Mailing Address - Phone:316-210-3313
Mailing Address - Fax:
Practice Address - Street 1:8433 CHURCH RANCH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-5547
Practice Address - Country:US
Practice Address - Phone:316-210-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015854225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist