Provider Demographics
NPI:1750856985
Name:SHELTON, JENNIFER JOHANNA (CCMA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOHANNA
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7828 VANCE DR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2124
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5560
Practice Address - Street 1:7828 VANCE DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2124
Practice Address - Country:US
Practice Address - Phone:303-425-0300
Practice Address - Fax:303-432-5560
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
CO376K00000X
COG8F3M5Z6376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide