MEDICARE: JENNY WILTSHIRE L.P.N.

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
1	164W00000X	Licensed Practical Nurse	26021	CO

General Provider Information

NPI Number	:	1275831950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY WILTSHIRE L.P.N.

Provider Business Mailing Address
First Line	:	1330 S POTOMAC ST STE 104A
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-4527
Country	:	US
Telephone Number	:	303-283-5991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 S POTOMAC ST STE 104A
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80012-4527
Country	:	US
Telephone Number	:	303-283-5991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	03/04/2011

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