Provider Demographics
NPI:1942221502
Name:BIRD, JEANNE M (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:BIRD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:M
Other - Last Name:LETOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3434 47TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1880
Mailing Address - Country:US
Mailing Address - Phone:303-444-0840
Mailing Address - Fax:303-444-0838
Practice Address - Street 1:3434 47TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1880
Practice Address - Country:US
Practice Address - Phone:303-444-0840
Practice Address - Fax:303-444-0838
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE817363A00000X
CO2048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45921512Medicaid
CO45921512Medicaid
COCO300303Medicare Oscar/Certification
COCO300303Medicare UPIN
COCO300303Medicare PIN