Provider Demographics
NPI:1275662009
Name:ECKHARDT, JENNIFER ALECSANDRA (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALECSANDRA
Last Name:ECKHARDT
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 1:457 SCHOONER LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-8615
Mailing Address - Country:US
Mailing Address - Phone:970-920-5427
Mailing Address - Fax:
Practice Address - Street 1:405 CASTLE CREEK RD STE 6
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-3125
Practice Address - Country:US
Practice Address - Phone:970-920-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO112927163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO112927OtherNURSING LICENSE