Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 5190 | CO |
NPI | 1023398054 |
---|---|
Provider Name | Dr. William Joel Jenkins |
First Address | Fort Collins, CO 80525-4336 |
Second Address | Fort Collins, CO 80525-4336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2011 |
Last Update Date | 22/08/2011 |