Healthcare Provider Details

I. General information

NPI: 1154065282
Provider Name (Legal Business Name): JENNIFER ANNA SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

IV. Provider business mailing address

2797 WEWATTA WAY UNIT 1020
DENVER CO
80216-3620
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax:
Mailing address:
  • Phone: 845-234-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN76960
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: