Individual
JIM GULTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
19053 E 51ST AVE, DENVER, CO 80249-8433
(303) 395-5558
Mailing address
19053 E 51ST AVE, DENVER, CO 80249-8433
(303) 395-5558
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
43575
CO
Other
Enumeration date
04/15/2012
Last updated
04/15/2012
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