Healthcare Provider Details

I. General information

NPI: 1275721755
Provider Name (Legal Business Name): JEAN VALERIE ZICCARDI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 E HARVARD AVE STE 400
DENVER CO
80231-5943
US

IV. Provider business mailing address

6554 S WINNIPEG CT
AURORA CO
80016-5204
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1492
  • Fax:
Mailing address:
  • Phone: 303-699-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number176434
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: