Provider Demographics
NPI:1841328226
Name:SEITZ, JYLENE (MT)
Entity type:Individual
Prefix:
First Name:JYLENE
Middle Name:
Last Name:SEITZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13083 TRENTON PLACE
Mailing Address - Street 2:
Mailing Address - City:THORTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602
Mailing Address - Country:US
Mailing Address - Phone:720-234-3611
Mailing Address - Fax:
Practice Address - Street 1:3130 S. PARKER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-369-6555
Practice Address - Fax:303-368-9237
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist