| Doctor Name: | DR. SELISA SMITSON JENKS MD |
| NPI Number: | 1013128339 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 30528 |
| Business Practice Address: | 202 E Cheyenne Mountain Blvd Colorado Springs, CO - 809063769 |
| Business Phone Number: | 7195796890 |
| Business Fax Number: | |
| Mailing Address: | 25 Maple Ave, COLORADO SPRINGS |
| State: | CO |
| Postal Code: | 809063137 |
| Phone Number: | 7193382118 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 30528 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |