Provider Demographics
NPI:1366638363
Name:BACH, JENNIFER EVELYN (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EVELYN
Last Name:BACH
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 1:6269 NORTHWOODS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5759
Mailing Address - Country:US
Mailing Address - Phone:720-842-5276
Mailing Address - Fax:
Practice Address - Street 1:6269 NORTHWOODS GLEN DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5759
Practice Address - Country:US
Practice Address - Phone:720-842-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO129232163WE0003X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO129232OtherCOLORADO NURSING LICENSE