Healthcare Provider Details

I. General information

NPI: 1215315551
Provider Name (Legal Business Name): JENNIFER CHENG EVANS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LINDA CHENG

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

2008 CARIBOU DR
FORT COLLINS CO
80525-4325
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-7000
  • Fax: 937-723-5016
Mailing address:
  • Phone: 970-484-4757
  • Fax: 970-484-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number67080
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number390200000X
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2362
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13482A
License Number StateWY
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0065611
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: