1548240609 NPI number — DR. JENNIFER V YULL D.P.M.

Table of content: DR. JENNIFER V YULL D.P.M. (NPI 1548240609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548240609 NPI number — DR. JENNIFER V YULL D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YULL
Provider First Name:
JENNIFER
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548240609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2975 BROADMOOR VALLEY RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80906-4466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-576-2080
Provider Business Mailing Address Fax Number:
719-576-2248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2975 BROADMOOR VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80906-4466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-576-2080
Provider Business Practice Location Address Fax Number:
719-576-2248
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  487 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 57883 . This is a "BCBS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 84146929103 . This is a "PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01004878 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 841469291001 . This is a "RMHMO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 480026777 . This is a "RRW MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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