Provider Demographics
NPI:1124668066
Name:GINGER JAR WELLNESS, PLLC
Entity type:Organization
Organization Name:GINGER JAR WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPL AC
Authorized Official - Phone:720-763-1133
Mailing Address - Street 1:795 MC INTYRE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-7410
Mailing Address - Country:US
Mailing Address - Phone:720-763-1133
Mailing Address - Fax:
Practice Address - Street 1:795 MC INTYRE ST STE 101
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-7410
Practice Address - Country:US
Practice Address - Phone:720-763-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service