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NPI Code Detail

MEDICARE: JORDAN MARIE ELLIS

MEDICARE: JORDAN MARIE ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN.1698694CO

General Provider Information

NPI Number : 1619830817
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN MARIE ELLIS
Provider Business Mailing Address
First Line : 4856 INNOVATION DR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-5539
Country : US
Telephone Number : 970-494-4200
Fax Number :
Provider Business Practice Location Address
First Line : 2260 W TRILBY RD
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-9650
Country : US
Telephone Number : 970-494-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/04/2025

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Directions to “ JORDAN MARIE ELLIS ” Practice Location

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