Provider Demographics
NPI:1649596917
Name:SPAIN, JENNIFER E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:E
Last Name:SPAIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:VILLELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2341 TERRARIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80126-2609
Mailing Address - Country:US
Mailing Address - Phone:720-280-4752
Mailing Address - Fax:
Practice Address - Street 1:8383 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3007
Practice Address - Country:US
Practice Address - Phone:800-632-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47536164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse