Provider Demographics
NPI:1548240609
Name:YULL, JENNIFER V (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:V
Last Name:YULL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2975 BROADMOOR VALLEY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4466
Mailing Address - Country:US
Mailing Address - Phone:719-576-2080
Mailing Address - Fax:719-576-2248
Practice Address - Street 1:2975 BROADMOOR VALLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4466
Practice Address - Country:US
Practice Address - Phone:719-576-2080
Practice Address - Fax:719-576-2248
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO487213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57883OtherBCBS
CO84146929103OtherPACIFICARE
CO01004878Medicaid
CO841469291001OtherRMHMO
CO480026777OtherRRW MEDICARE
CO84146929103OtherPACIFICARE
CO57883OtherBCBS
CO480026777OtherRRW MEDICARE