Provider Demographics
NPI:1710099908
Name:JANKOWSKI, BETH ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:401 W HAMPDEN PL
Mailing Address - Street 2:STE 240
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2471
Mailing Address - Country:US
Mailing Address - Phone:303-788-7880
Mailing Address - Fax:303-788-7883
Practice Address - Street 1:401 W HAMPDEN PL
Practice Address - Street 2:240
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2470
Practice Address - Country:US
Practice Address - Phone:303-788-7880
Practice Address - Fax:303-788-7883
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1087363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO232058Medicare ID - Type Unspecified
COS70349Medicare UPIN