Healthcare Provider Details

I. General information

NPI: 1104983998
Provider Name (Legal Business Name): JENNIFER G DOYLE NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MAXWELL AVE
BOULDER CO
80304-3972
US

IV. Provider business mailing address

4747 ARAPAHOE AVE
BOULDER CO
80303-1133
US

V. Phone/Fax

Practice location:
  • Phone: 303-544-5777
  • Fax: 303-544-5775
Mailing address:
  • Phone: 720-854-7152
  • Fax: 720-854-7114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number4648
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00107760
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: