Healthcare Provider Details

I. General information

NPI: 1174984587
Provider Name (Legal Business Name): JESSICA M NANCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4087
US

IV. Provider business mailing address

7155 E 38TH AVE
DENVER CO
80207-1630
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-7162
  • Fax: 719-475-2201
Mailing address:
  • Phone: 303-321-2458
  • Fax: 303-321-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1620316
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: