Healthcare Provider Details

I. General information

NPI: 1174178107
Provider Name (Legal Business Name): JEAN BAUMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 N CIRCLE DR
COLORADO SPRINGS CO
80909-1179
US

IV. Provider business mailing address

3027 N CIRCLE DR
COLORADO SPRINGS CO
80909-1179
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-3611
  • Fax: 719-776-3610
Mailing address:
  • Phone: 719-776-3611
  • Fax: 719-776-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number0082629
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: