Healthcare Provider Details

I. General information

NPI: 1386607869
Provider Name (Legal Business Name): JENNIFER MARIE FARMER ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 WASHINGTON ST
MONUMENT CO
80132-9173
US

IV. Provider business mailing address

PO BOX 1068
PALMER LAKE CO
80133-1068
US

V. Phone/Fax

Practice location:
  • Phone: 719-209-4232
  • Fax:
Mailing address:
  • Phone: 719-209-4232
  • Fax: 719-481-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1187
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: