Healthcare Provider Details

I. General information

NPI: 1023987724
Provider Name (Legal Business Name): JONATHAN EDWARD LEJEUNE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ALPINE AVE
BOULDER CO
80304-3406
US

IV. Provider business mailing address

11823 RIDGE PKWY APT 817
BROOMFIELD CO
80021-5099
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1688085
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: