Healthcare Provider Details

I. General information

NPI: 1053922831
Provider Name (Legal Business Name): JENNA GILBERT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTH PARK DR
LOUISVILLE CO
80027-9583
US

IV. Provider business mailing address

3920 N 109TH ST
LAFAYETTE CO
80026-9662
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-1088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN.0202885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: