Provider Demographics
NPI:1386390581
Name:CLEMENTS, NICOLE LYNN (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10413 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-7355
Mailing Address - Country:US
Mailing Address - Phone:303-921-8258
Mailing Address - Fax:
Practice Address - Street 1:10413 GARLAND DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-7355
Practice Address - Country:US
Practice Address - Phone:303-921-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109111163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841250135OtherNEW WEST PHYSICIANS