Healthcare Provider Details

I. General information

NPI: 1780576942
Provider Name (Legal Business Name): REGENERATIVE HEALTH AND WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 SILVERSTONE TER STE 250
COLORADO SPRINGS CO
80919-3545
US

IV. Provider business mailing address

5731 SILVERSTONE TER STE 250
COLORADO SPRINGS CO
80919-3545
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-0144
  • Fax:
Mailing address:
  • Phone: 719-635-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HOLDREN
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-635-0144