Basic Information
| Provider Information | |||||||||
| NPI: | 1043522840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YANOSIK | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 W. HAMPDEN AVE. | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | COLORADO | ||||||||
| PostalCode: | 80110 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 3037615646 | ||||||||
| FaxNumber: | 3037619280 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 W HAMPDEN AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801102330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037615646 | ||||||||
| FaxNumber: | 3037619280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 10/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 53802 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 41556020 | 05 | CO | MEDICAID |