Provider Demographics
NPI:1851493936
Name:PICERNO, NICOLETTE ANGELICA (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:ANGELICA
Last Name:PICERNO
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 1:850 E HARVARD AVE
Mailing Address - Street 2:STE #505
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-744-1961
Mailing Address - Fax:303-744-1110
Practice Address - Street 1:850 E HARVARD AVE STE 505
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5078
Practice Address - Country:US
Practice Address - Phone:303-744-1961
Practice Address - Fax:303-744-1110
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38744207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30057779Medicaid
CO38744OtherSTATE
COBP4630302OtherDEA
CO30057779Medicaid
COC95778Medicare PIN