Provider Demographics
NPI:1912916784
Name:STOTLER, JEANNE K (NP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:K
Last Name:STOTLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E GEDDES AVE
Mailing Address - Street 2:# 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:303-761-6278
Practice Address - Street 1:8200 E BELLEVIEW AVE STE 102
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2804
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:303-761-6278
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96196363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79709273Medicaid
COP00111016OtherRAILROAD MEDICARE MIC
P21378Medicare UPIN
COC456968Medicare PIN
COC456958Medicare PIN