Healthcare Provider Details

I. General information

NPI: 1992542708
Provider Name (Legal Business Name): JENNIFER STEVENS HALL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

2904 SHADY HOLW W
BOULDER CO
80304-2902
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-4000
  • Fax:
Mailing address:
  • Phone: 720-308-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999931-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: