Provider Demographics
NPI:1003975806
Name:DAILEY VAIL, JENNIFER (RN, NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAILEY VAIL
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 W OXFORD AVE
Mailing Address - Street 2:UNIT G3
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3106
Mailing Address - Country:US
Mailing Address - Phone:303-797-4260
Mailing Address - Fax:
Practice Address - Street 1:3525 W OXFORD AVE
Practice Address - Street 2:UNIT G3
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3106
Practice Address - Country:US
Practice Address - Phone:303-797-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101615363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91622280Medicaid