Provider Demographics
NPI:1245213404
Name:NORMAN, JENNIFER COLEMAN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COLEMAN
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:2555 E 13TH ST
Practice Address - Street 2:STE 130
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537
Practice Address - Country:US
Practice Address - Phone:970-663-5437
Practice Address - Fax:970-669-5762
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0725572Medicaid
WY118974300Medicaid
CO94276781Medicaid
CONO641834OtherANTHEM BCBS
CA4705637Medicaid
ID807417700Medicaid
CA4705637Medicaid
CA4705637Medicaid