MEDICARE: MRS. JILL C VESTY N.P.

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	363LF0000X	Family Nurse Practitioner	172722	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	248449	OTHER	NE	MIDLANDS CHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922072453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL C VESTY N.P.

Provider Business Mailing Address
First Line	:	COLORADO STATE UNIVERSITY HEALTH NETWORK
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80523-0001
Country	:	US
Telephone Number	:	970-491-7121
Fax Number	:

Provider Business Practice Location Address
First Line	:	COLORADO STATE UNIVERSITY HEALTH NETWORK
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80523-0001
Country	:	US
Telephone Number	:	970-491-7121
Fax Number	:

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	09/21/2011

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