Healthcare Provider Details

I. General information

NPI: 1730597220
Provider Name (Legal Business Name): JENA CELLA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 10/21/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9197 GRANT ST SUITE 200
THORNTON CO
80229-4329
US

IV. Provider business mailing address

9197 GRANT ST SUITE 200
THORNTON CO
80229-4329
US

V. Phone/Fax

Practice location:
  • Phone: 303-450-3690
  • Fax: 303-450-3699
Mailing address:
  • Phone: 303-450-3690
  • Fax: 303-450-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0004018
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: