Healthcare Provider Details

I. General information

NPI: 1851441463
Provider Name (Legal Business Name): JENNIFER M. LYTLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 E. EXPOSITION AVE SUITE 100
DENVER CO
80209
US

IV. Provider business mailing address

2601 S. QUEBEC ST. #16
DENVER CO
80231
US

V. Phone/Fax

Practice location:
  • Phone: 720-316-8228
  • Fax:
Mailing address:
  • Phone: 303-437-8312
  • Fax: 720-500-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number43293
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: