MEDICARE: MS. VIRGINIA C GILLISPIE ND, CNS, ACHPN, CCM

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	163W00000X	Registered Nurse	112546	CO
2	364S00000X	Clinical Nurse Specialist	3310	CO
3	363L00000X	Nurse Practitioner	991091	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015038	OTHER		KAISER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730216771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA C GILLISPIE ND, CNS, ACHPN, CCM

Provider Business Mailing Address
First Line	:	PO BOX 560825
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80256-0825
Country	:	US
Telephone Number	:	719-595-7580
Fax Number	:	719-545-0176

Provider Business Practice Location Address
First Line	:	1619 N. GRAND AVE.
Second Line	:	STE 402
City	:	PUEBLO
State	:	CO
Zip	:	81003-2658
Country	:	US
Telephone Number	:	719-595-7760
Fax Number	:	719-595-7765

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	01/29/2018

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