Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 39453 | CO |
NPI | 1134127012 |
---|---|
Provider Name | Betty J. Jennings |
First Address | Denver, CO 80246-1226 |
Second Address | Denver, CO 80246-1226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 17/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021719 | KAISER COMMERCIAL NUMBER (01) | CO |
07025422 | (05) | CO |