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General NPI Number Information
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NPI Number | 1790701589
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Entity Type | Individual
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Provider Name | JENNIFER B DE GORTARI CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 501 E HAMPDEN AVE
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2702
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Country | US
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Telephone | 303-788-6749
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Fax |
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Provider Business Mailing Address
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Address Line | 3531 S LOGAN ST UNIT D408
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City | ENGLEWOOD
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State | CO
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Zip | 80113-3700
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Country | US
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Telephone | 303-788-6749
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 118813
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRA-4885
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License Number State | CO
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