Provider Demographics
NPI:1104479302
Name:NYKANEN, NIINA (FNP)
Entity type:Individual
Prefix:
First Name:NIINA
Middle Name:
Last Name:NYKANEN
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 1:49 GRAYS PEAK TRL
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-7649
Mailing Address - Country:US
Mailing Address - Phone:906-235-7176
Mailing Address - Fax:
Practice Address - Street 1:8199 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7163
Practice Address - Country:US
Practice Address - Phone:720-370-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60938809163W00000X
CORN.0205201163WG0000X
WAAP60975919363LF0000X
COAPN.0994940-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice