Provider Demographics
NPI:1528480373
Name:DIDELOT, NICHOLE CALAGIAS (CPM, CLC)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:CALAGIAS
Last Name:DIDELOT
Suffix:
Gender:F
Credentials:CPM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8590 N 39TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8840
Mailing Address - Country:US
Mailing Address - Phone:303-669-9605
Mailing Address - Fax:720-438-7308
Practice Address - Street 1:8590 N 39TH ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-8840
Practice Address - Country:US
Practice Address - Phone:303-669-9605
Practice Address - Fax:720-438-7308
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO153176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife