Basic Information
| Provider Information | |||||||||
| NPI: | 1477910024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | N.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2620 E PROSPECT RD STE 190 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805259098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702211106 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2620 E PROSPECT RD STE 190 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805259098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702211106 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2016 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175F00000X | 000017 | CO | Y | Other Service Providers | Naturopath |
No ID Information.