Provider Demographics
NPI:1366336661
Name:BURNS, NICOLE R (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:BURNS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:MALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:215 COTTON ST # 80701
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3940
Mailing Address - Country:US
Mailing Address - Phone:970-380-9064
Mailing Address - Fax:
Practice Address - Street 1:212 E KIOWA AVE STE 7
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3135
Practice Address - Country:US
Practice Address - Phone:970-380-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty