Healthcare Provider Details

I. General information

NPI: 1053624957
Provider Name (Legal Business Name): JAMIE FETZER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 FRANKLIN ST
DENVER CO
80205-5437
US

IV. Provider business mailing address

2186 S HUMBOLDT ST
DENVER CO
80210-4619
US

V. Phone/Fax

Practice location:
  • Phone: 303-764-5398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number190803
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: