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General NPI Number Information
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NPI Number | 1811466071
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Entity Type | Individual
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Provider Name | JENNIFER CIRAK HUSKINSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 1400 E BOULDER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-365-5095
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Fax | 719-365-6595
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Provider Business Mailing Address
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Address Line | 1400 E BOULDER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-365-5095
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0994313-NP
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License Number State | CO
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