Provider Demographics
NPI:1639905300
Name:VANDERLINDEN, NICOLE MARIE
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:VANDERLINDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 E EVANS AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-4720
Mailing Address - Country:US
Mailing Address - Phone:714-299-2235
Mailing Address - Fax:
Practice Address - Street 1:2375 E EVANS AVE APT 10
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-4720
Practice Address - Country:US
Practice Address - Phone:714-299-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0023905225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty