Doctor Name: | NICOLE JEANETTE VANDAS |
NPI Number: | 1427301555 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ANP |
License Number: | APN.0990523-NP |
Business Practice Address: | 455 Kokopelli Blvd Unit C Fruita, CO - 815218710 |
Business Phone Number: | 9702451220 |
Business Fax Number: | 9702459148 |
Mailing Address: | Po Box 10700, GRAND JUNCTION |
State: | CO |
Postal Code: | 815025517 |
Phone Number: | 9702451220 |
Fax Number: | 9702459148 |
NPI Enumeration Date: | 10/26/2012 |
NPI Last Update Date: | 01/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN.0990523-NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |