Healthcare Provider Details

I. General information

NPI: 1952002271
Provider Name (Legal Business Name): JORDAN CLOSE RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 S LOWELL BLVD
DENVER CO
80236-3604
US

IV. Provider business mailing address

1707 COLE BLVD STE 100
GOLDEN CO
80401-3219
US

V. Phone/Fax

Practice location:
  • Phone: 866-274-0907
  • Fax:
Mailing address:
  • Phone: 866-274-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number164440
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: