Provider Demographics
NPI:1982843884
Name:GATLIN, NIKO QUETISH
Entity Type:Individual
Prefix:
First Name:NIKO
Middle Name:QUETISH
Last Name:GATLIN
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 1:700 COLORADO BLVD
Mailing Address - Street 2:318
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 COLORADO BLVD
Practice Address - Street 2:318
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4084
Practice Address - Country:US
Practice Address - Phone:866-801-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO702709376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide