Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 101615 | CO |
NPI | 1003975806 |
---|---|
Provider Name | Jennifer Dailey Vail |
First Address | Denver, CO 80236-3106 |
Second Address | Denver, CO 80236-3106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
91622280 | (05) | CO |