MEDICARE: JENEFFER HARGIS RN

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
1	163W00000X	Registered Nurse	1649308	CO
2	163W00000X	Registered Nurse	202109557	OR

General Provider Information

NPI Number	:	1841000742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENEFFER HARGIS RN

Provider Business Mailing Address
First Line	:	7630 CHANCELLOR DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7143
Country	:	US
Telephone Number	:	719-271-9973
Fax Number	:

Provider Business Practice Location Address
First Line	:	10126 SW PARK WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5008
Country	:	US
Telephone Number	:	503-215-4646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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