Healthcare Provider Details

I. General information

NPI: 1598853293
Provider Name (Legal Business Name): GENNIFER GIUSTINA RN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 E 9TH AVE BOX C 2885 ROOM 1503
DENVER CO
80262-0001
US

IV. Provider business mailing address

13624 N TRAVOIS TRL
PARKER CO
80138-8617
US

V. Phone/Fax

Practice location:
  • Phone: 303-315-5213
  • Fax:
Mailing address:
  • Phone: 303-841-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number57477
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: