Healthcare Provider Details

I. General information

NPI: 1982854931
Provider Name (Legal Business Name): ELIZABETH ANN JANICH WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY STE 200
LONE TREE CO
80124-5525
US

IV. Provider business mailing address

10103 RIDGEGATE PKWY STE 200
LONE TREE CO
80124-5525
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-6657
  • Fax: 303-788-8837
Mailing address:
  • Phone: 303-788-6657
  • Fax: 303-788-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.0993829-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: