Provider Demographics
NPI:1922385020
Name:FEARON, JACQUELINE DENISE (RN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:DENISE
Last Name:FEARON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E GEDDES AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3861
Mailing Address - Country:US
Mailing Address - Phone:720-493-3403
Mailing Address - Fax:720-874-4423
Practice Address - Street 1:10700 E GEDDES AVE STE 200
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3861
Practice Address - Country:US
Practice Address - Phone:720-493-3403
Practice Address - Fax:720-874-4423
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO173716163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator