Provider Demographics
NPI:1689715823
Name:JEFFERSON, PHYLLIS EILEEN (NP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:EILEEN
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 WARD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1300
Mailing Address - Country:US
Mailing Address - Phone:303-422-6331
Mailing Address - Fax:303-422-6379
Practice Address - Street 1:5730 WARD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1300
Practice Address - Country:US
Practice Address - Phone:303-422-6331
Practice Address - Fax:303-422-6379
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44567OtherLICENSE #
DCMJ0886501OtherDEA #
DCMJ0886501OtherDEA #
CO44567OtherLICENSE #