MEDICARE: JANET MARIE CREELMAN 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
1	163W00000X	Registered Nurse	190727	CO

General Provider Information

NPI Number	:	1396005047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MARIE CREELMAN RN

Provider Business Mailing Address
First Line	:	9025 MELBOURNE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7713
Country	:	US
Telephone Number	:	719-358-7525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5373 N UNION BLVD
Second Line	:	# 101
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2073
Country	:	US
Telephone Number	:	719-577-4448
Fax Number	:

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

Provider Enumeration Date	:	05/28/2012
Last Update Date	:	05/28/2012

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