Healthcare Provider Details

I. General information

NPI: 1598275109
Provider Name (Legal Business Name): JENNIFER AMALIE VINH CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER AMALIE TRUJILLO CNS

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number0993452
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPN.0993452-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: