Healthcare Provider Details

I. General information

NPI: 1770305906
Provider Name (Legal Business Name): JENNIFER YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 BYRD DR
LOVELAND CO
80538-7198
US

IV. Provider business mailing address

1603 RED MOUNTAIN DR
LONGMONT CO
80504-2297
US

V. Phone/Fax

Practice location:
  • Phone: 970-962-4900
  • Fax: 970-962-4901
Mailing address:
  • Phone: 303-304-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0174821
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: