Healthcare Provider Details

I. General information

NPI: 1447564109
Provider Name (Legal Business Name): PHILLIS JEWELL RUTT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PHILLIS JEWELL RUTT NP-C

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 E HAMPDEN AVE STE 300
ENGLEWOOD CO
80113-2762
US

IV. Provider business mailing address

4900 S MONACO ST STE 210
DENVER CO
80237-3487
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-6490
  • Fax: 303-788-5451
Mailing address:
  • Phone: 303-563-2784
  • Fax: 303-563-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-10128
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: