Individual
MALENA MICHELLE NICODEMUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2400 S PEORIA ST, #100, AURORA, CO 80014-5476
(303) 306-4321
(303) 306-4347
Mailing address
2400 S PEORIA ST, #100, AURORA, CO 80014-5476
(303) 306-4321
(303) 306-4347
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2618
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91423287
—
CO
Enumeration date
07/31/2008
Last updated
09/09/2012
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