Provider Demographics
NPI:1891404059
Name:MCGEE, NICOLE W (DA)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:W
Last Name:MCGEE
Suffix:
Gender:F
Credentials:DA
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DA
Mailing Address - Street 1:2014 CARIBOU DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4330
Mailing Address - Country:US
Mailing Address - Phone:970-225-9555
Mailing Address - Fax:970-223-2294
Practice Address - Street 1:2014 CARIBOU DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4330
Practice Address - Country:US
Practice Address - Phone:970-225-9555
Practice Address - Fax:970-223-2294
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COST.0005541246ZI1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZI1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherIllustration, Medical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COST.0005541OtherINDIVIDUAL