Provider Demographics
NPI:1396060216
Name:ROWE, NICOLE ALYSSA (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALYSSA
Last Name:ROWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ALYSSA
Other - Last Name:MAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:28267 HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7553
Mailing Address - Country:US
Mailing Address - Phone:720-634-6789
Mailing Address - Fax:720-302-2182
Practice Address - Street 1:28267 HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7553
Practice Address - Country:US
Practice Address - Phone:720-634-6789
Practice Address - Fax:720-302-2182
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-03
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine