Healthcare Provider Details

I. General information

NPI: 1407050321
Provider Name (Legal Business Name): JILL ELLEN ANDERSON RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8779 INDIAN VILLAGE DR
WELLINGTON CO
80549-1792
US

IV. Provider business mailing address

8779 INDIAN VILLAGE DR
WELLINGTON CO
80549-1792
US

V. Phone/Fax

Practice location:
  • Phone: 970-201-5931
  • Fax:
Mailing address:
  • Phone: 970-201-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2825
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: