Provider Demographics
NPI:1730564535
Name:MYERS, NICOLE ERIN (CNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ERIN
Last Name:MYERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 BLUE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2004
Mailing Address - Country:US
Mailing Address - Phone:970-498-6794
Mailing Address - Fax:970-498-6772
Practice Address - Street 1:1525 BLUE SPRUCE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2004
Practice Address - Country:US
Practice Address - Phone:970-498-6794
Practice Address - Fax:970-498-6772
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1643665163W00000X
WY50913363LP0200X
COAPN.0992864-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse