Healthcare Provider Details

I. General information

NPI: 1487156378
Provider Name (Legal Business Name): JENNIFER RAE WILLIAMS RN, BSN, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 PARK MEADOWS DR
LONE TREE CO
80124-5425
US

IV. Provider business mailing address

2500 S HAVANA ST
AURORA CO
80014-1618
US

V. Phone/Fax

Practice location:
  • Phone: 303-649-5626
  • Fax:
Mailing address:
  • Phone: 303-919-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number179948
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: