Provider Demographics
NPI:1750399580
Name:VERMILYEN, JOHN K (NP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:VERMILYEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 N. THUNDERBIRD CIRCLE
Mailing Address - Street 2:STE. 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1219
Mailing Address - Country:US
Mailing Address - Phone:888-705-8558
Mailing Address - Fax:480-832-0268
Practice Address - Street 1:4590 W 121ST AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5666
Practice Address - Country:US
Practice Address - Phone:303-439-4544
Practice Address - Fax:303-439-9363
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0003609-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98155539Medicaid
CO98155539Medicaid
CO803363Medicare ID - Type Unspecified