MEDICARE: EILEEN MARIE VERLIE 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	45802	CO

General Provider Information

NPI Number	:	1649444753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN MARIE VERLIE LPN

Provider Business Mailing Address
First Line	:	765 W CLEVELAND CIR
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-1026
Country	:	US
Telephone Number	:	303-665-0704
Fax Number	:

Provider Business Practice Location Address
First Line	:	765 W CLEVELAND CIR
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-1026
Country	:	US
Telephone Number	:	303-665-0704
Fax Number	:

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

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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