Provider Demographics
NPI:1902183189
Name:JANSEN, JILL CHRISTINE
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1515
Mailing Address - Country:US
Mailing Address - Phone:303-398-6066
Mailing Address - Fax:303-398-5539
Practice Address - Street 1:6200 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1515
Practice Address - Country:US
Practice Address - Phone:303-398-6066
Practice Address - Fax:303-398-5539
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist