Provider Demographics
NPI:1538316914
Name:HITES, JACQUELYN J (CNM)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:J
Last Name:HITES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-322-2240
Mailing Address - Fax:303-322-9260
Practice Address - Street 1:2055 HIGH ST
Practice Address - Street 2:#140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5504
Practice Address - Country:US
Practice Address - Phone:303-322-2240
Practice Address - Fax:303-322-9260
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1739367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07879083Medicaid
CO07879083Medicaid