Healthcare Provider Details

I. General information

NPI: 1720294622
Provider Name (Legal Business Name): JILL BEA ANDERSON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 S BROADWAY
LITTLETON CO
80122-2602
US

IV. Provider business mailing address

1362 PINE VIEW RD
GOLDEN CO
80403-1394
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-5832
  • Fax: 303-734-2038
Mailing address:
  • Phone: 303-384-0167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number52691
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: