Provider Demographics
NPI:1457118796
Name:VRBANCIC, NICHOLAS DOMENCIO
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DOMENCIO
Last Name:VRBANCIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10962 ELM DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-5472
Mailing Address - Country:US
Mailing Address - Phone:505-340-5166
Mailing Address - Fax:
Practice Address - Street 1:10962 ELM DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-5472
Practice Address - Country:US
Practice Address - Phone:505-340-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1647647163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse