Healthcare Provider Details

I. General information

NPI: 1730458605
Provider Name (Legal Business Name): JENIFER KOBERSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 INVERNESS DR W
ENGLEWOOD CO
80112-5095
US

IV. Provider business mailing address

155 INVERNESS DR W
ENGLEWOOD CO
80112-5095
US

V. Phone/Fax

Practice location:
  • Phone: 303-347-6593
  • Fax:
Mailing address:
  • Phone: 303-347-6593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN-31405
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: