Provider Demographics
NPI:1376017392
Name:JEBENS, BRIANA RIDGWAY
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:RIDGWAY
Last Name:JEBENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 WINDMILL CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-9180
Mailing Address - Country:US
Mailing Address - Phone:970-250-6331
Mailing Address - Fax:
Practice Address - Street 1:3702 AUTOMATION WAY STE 103
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5738
Practice Address - Country:US
Practice Address - Phone:970-223-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1627987367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered