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General NPI Number Information
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NPI Number | 1538055314
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Entity Type | Organization
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Legal Business Name | ESSENTIAL MENOPAUSE CARE, LLC
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 721 JACKSON ST
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City | PUEBLO
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State | CO
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Zip | 81004-1711
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Country | US
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Telephone | 719-752-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 448 S MCCULLOCH BLVD
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City | PUEBLO WEST
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State | CO
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Zip | 81007-2888
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Country | US
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Telephone | 719-752-8487
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KENDRA FEJEDELEM
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Credential | FNP-BC
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Telephone | 719-752-8487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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