Individual
GROVER NICODEMUS STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10240 PARK MEADOWS DR, LONE TREE, CO 80124-5425
(303) 338-4545
Mailing address
1 RED FOX LN, LITTLETON, CO 80127-5710
(307) 421-8332
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0168533
CO
163W00000X
Registered Nurse
RN0168533
CO
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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