Provider Demographics
NPI:1518782770
Name:NICKS, CHRISTINE DAWN
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DAWN
Last Name:NICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 MOCCASIN PASS CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4452
Mailing Address - Country:US
Mailing Address - Phone:719-694-6483
Mailing Address - Fax:
Practice Address - Street 1:6345 MOCCASIN PASS CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4452
Practice Address - Country:US
Practice Address - Phone:719-694-6483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN.0109348-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily