Healthcare Provider Details

I. General information

NPI: 1104219294
Provider Name (Legal Business Name): JOLENE RENE CHADWICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY
LONE TREE CO
80124-5520
US

IV. Provider business mailing address

8220 HOLLAND CT
ARVADA CO
80005-2245
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-8888
  • Fax:
Mailing address:
  • Phone: 303-653-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193897
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: