Provider Demographics
NPI:1770807430
Name:GOTTINO, JANA LYNN (LMP,RN)
Entity type:Individual
Prefix:MS
First Name:JANA
Middle Name:LYNN
Last Name:GOTTINO
Suffix:
Gender:F
Credentials:LMP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MEADOW RUN DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3757
Mailing Address - Country:US
Mailing Address - Phone:970-481-6777
Mailing Address - Fax:
Practice Address - Street 1:701 MEADOW RUN DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3757
Practice Address - Country:US
Practice Address - Phone:970-481-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2701825173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist