Provider Demographics
NPI:1154487494
Name:GILMORE, MONA JEAN (NP)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:JEAN
Last Name:GILMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SANDLER DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2536
Mailing Address - Country:US
Mailing Address - Phone:303-665-7900
Mailing Address - Fax:720-887-4663
Practice Address - Street 1:103 SANDLER DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2536
Practice Address - Country:US
Practice Address - Phone:303-665-7900
Practice Address - Fax:720-887-4663
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111159363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health