MEDICARE: MRS. STACY R JHA LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	38251	CO

General Provider Information

NPI Number	:	1235339292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY R JHA LPN

Provider Business Mailing Address
First Line	:	335 DETROIT ST
Second Line	:	101
City	:	DENVER
State	:	CO
Zip	:	80206-4371
Country	:	US
Telephone Number	:	303-398-6142
Fax Number	:

Provider Business Practice Location Address
First Line	:	335 DETROIT ST
Second Line	:	101
City	:	DENVER
State	:	CO
Zip	:	80206-4371
Country	:	US
Telephone Number	:	720-272-3726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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