Individual
NICOLLETTE WALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
10200 PARK MEADOWS DR UNIT 732, LONE TREE, CO 80124-5461
(801) 419-7308
Mailing address
10200 PARK MEADOWS DR UNIT 732, LONE TREE, CO 80124-5461
(801) 419-7308
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
STUDENT
CO
Other
Enumeration date
12/20/2025
Last updated
12/20/2025
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