Healthcare Provider Details

I. General information

NPI: 1740406909
Provider Name (Legal Business Name): JENNIFER E. SUCHON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER E. DANIELSON CPNP

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 N. UNCOMPAHGRE AVE.
MONTROSE CO
81401-3831
US

IV. Provider business mailing address

2233 E MAIN ST
MONTROSE CO
81401-3831
US

V. Phone/Fax

Practice location:
  • Phone: 970-240-6438
  • Fax: 970-249-8902
Mailing address:
  • Phone: 970-497-8416
  • Fax: 970-497-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0005776-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024167305
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0005776-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: