Provider Demographics
NPI:1194148940
Name:JAVORNIK, ROSE MARIE
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARIE
Last Name:JAVORNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 VERDE RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-9735
Mailing Address - Country:US
Mailing Address - Phone:719-676-7439
Mailing Address - Fax:
Practice Address - Street 1:5601 VERDE RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-9735
Practice Address - Country:US
Practice Address - Phone:719-676-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0011620314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility