Individual
JACI KAYLA CORLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN, CNA
Contact information
Practice address
700 CENTRE AVE, FORT COLLINS, CO 80526-2023
(970) 494-4200
Mailing address
4856 INNOVATION DR STE B, FORT COLLINS, CO 80525-5540
(970) 494-4200
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.0335643
CO
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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