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General NPI Number Information
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NPI Number | 1821714916
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Entity Type | Individual
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Provider Name | JENNIFER JEAN POULSON FNP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 8010 S COUNTY ROAD 5 UNIT 205
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City | FORT COLLINS
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State | CO
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Zip | 80528-9004
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Country | US
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Telephone | 888-777-2718
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Fax |
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Provider Business Mailing Address
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Address Line | 2609 LAKE HOLLOW RD
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City | BERTHOUD
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State | CO
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Zip | 80513-8412
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Country | US
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Telephone | 303-565-9088
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0998003-NP
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License Number State | CO
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