Individual
NICOLE M SHOWALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
620 IRIS DR, STERLING, CO 80751-4716
(970) 522-7266
(970) 522-4258
Mailing address
620 IRIS DR, STERLING, CO 80751-4716
(970) 522-7266
(970) 522-4258
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.0004571
COLORADO STATE LICENSE
CO
Enumeration date
01/12/2016
Last updated
03/15/2016
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