Provider Demographics
NPI:1336474006
Name:MOLTZ, JAMES PATRICK (LPN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:MOLTZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 E GIRARD PL APT 1033B
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-9151
Mailing Address - Country:US
Mailing Address - Phone:870-917-4297
Mailing Address - Fax:
Practice Address - Street 1:1715 E GIRARD PL APT 1033B
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-9151
Practice Address - Country:US
Practice Address - Phone:870-917-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43465164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43465OtherLPN LICENSE #