Individual
NICOLE NEWSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10434 BLUEGRASS ST, FIRESTONE, CO 80504-4516
(720) 256-5191
Mailing address
10434 BLUEGRASS ST, FIRESTONE, CO 80504-4516
(720) 256-5191
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
03/23/2016
Last updated
03/23/2016
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