Healthcare Provider Details

I. General information

NPI: 1881882512
Provider Name (Legal Business Name): JENNIFER LAVON GLASGOW RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

725 MADISON WAY
BENNETT CO
80102-7835
US

V. Phone/Fax

Practice location:
  • Phone: 303-889-9250
  • Fax:
Mailing address:
  • Phone: 303-889-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0200245
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0200245
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: