Provider Demographics
NPI:1164198149
Name:AXEL, JESSICA LAURA (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAURA
Last Name:AXEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9047 S YOSEMITE ST UNIT 1705
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2972
Mailing Address - Country:US
Mailing Address - Phone:913-669-1149
Mailing Address - Fax:
Practice Address - Street 1:9047 S YOSEMITE ST UNIT 1705
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2972
Practice Address - Country:US
Practice Address - Phone:913-669-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1640707163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency