1003088840 NPI number — JENNY MILD CONNERY M.D.

Table of content: JENNY MILD CONNERY M.D. (NPI 1003088840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003088840 NPI number — JENNY MILD CONNERY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNERY
Provider First Name:
JENNY
Provider Middle Name:
MILD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1003088840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 FOUNDERS PL
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
ASPEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81611-1476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-920-0104
Provider Business Mailing Address Fax Number:
970-920-0124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 FOUNDERS PL
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
ASPEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81611-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-920-0104
Provider Business Practice Location Address Fax Number:
970-920-0124
Provider Enumeration Date:
04/01/2008

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 48269 , 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)





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