Healthcare Provider Details

I. General information

NPI: 1457199242
Provider Name (Legal Business Name): JENNA PEARCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W NORTH ST
CORTEZ CO
81321-3119
US

IV. Provider business mailing address

106 W NORTH ST
CORTEZ CO
81321-3119
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-3056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1684757
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1684757
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: