Provider Demographics
NPI:1265698005
Name:VANVRANKEN, JOLENE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:VANVRANKEN
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 1:41 MONTEBELLO RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1379
Mailing Address - Country:US
Mailing Address - Phone:719-545-2746
Mailing Address - Fax:719-542-9638
Practice Address - Street 1:41 MONTEBELLO RD
Practice Address - Street 2:SUITE LL2
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1379
Practice Address - Country:US
Practice Address - Phone:719-545-2746
Practice Address - Fax:719-542-9347
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0035331164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse