Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | ANP0990467 | CO |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APN.0990467-NP | CO |
NPI | 1487958070 |
---|---|
Provider Name | Mark Jankelow |
First Address | Colorado Springs, CO 80904-4023 |
Second Address | Colorado Springs, CO 80904-4023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2010 |
Last Update Date | 10/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87108518 | (05) | CO |
COA109257 | (02) | CO |