Provider Demographics
NPI:1295851400
Name:DODGE, NANCEE LYNN (FNP)
Entity type:Individual
Prefix:MS
First Name:NANCEE
Middle Name:LYNN
Last Name:DODGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GREY TALON CT
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-3330
Mailing Address - Country:US
Mailing Address - Phone:970-925-1935
Mailing Address - Fax:
Practice Address - Street 1:401 CASTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1159
Practice Address - Country:US
Practice Address - Phone:970-544-1375
Practice Address - Fax:970-544-7347
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105308363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20401051Medicaid
840742145OtherEIN
CO20401051Medicaid