Healthcare Provider Details

I. General information

NPI: 1548240609
Provider Name (Legal Business Name): JENNIFER V YULL D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 BROADMOOR VALLEY RD SUITE 104
COLORADO SPRINGS CO
80906-4466
US

IV. Provider business mailing address

2975 BROADMOOR VALLEY RD SUITE 104
COLORADO SPRINGS CO
80906-4466
US

V. Phone/Fax

Practice location:
  • Phone: 719-576-2080
  • Fax: 719-576-2248
Mailing address:
  • Phone: 719-576-2080
  • Fax: 719-576-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number487
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: