Healthcare Provider Details

I. General information

NPI: 1164729158
Provider Name (Legal Business Name): JINNY JOY LAROCK RN, BCIAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. VIRGINIA JOY LAROCK

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 W BELLEVIEW AVE
ENGLEWOOD CO
80110-6701
US

IV. Provider business mailing address

499 W BELLEVIEW AVE
ENGLEWOOD CO
80110-6701
US

V. Phone/Fax

Practice location:
  • Phone: 303-667-6048
  • Fax: 303-433-1899
Mailing address:
  • Phone: 303-667-6048
  • Fax: 303-433-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number39172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: