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NPI Code Detail

MEDICARE: JILL L GRIVETTI RN

MEDICARE: JILL L GRIVETTI RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse163905CO

General Provider Information

NPI Number : 1174795256
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL L GRIVETTI RN
Provider Business Mailing Address
First Line : 2400 24TH AVE
Second Line :
City : LONGMONT
State : CO
Zip : 80503-8140
Country : US
Telephone Number : 303-772-5216
Fax Number :
Provider Business Practice Location Address
First Line : 280 EXEMPLA CIR
Second Line : ROCK CREEK MEDICAL OFFICES
City : LAFAYETTE
State : CO
Zip : 80026-3370
Country : US
Telephone Number : 720-536-6806
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2008
Last Update Date : 03/28/2008

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