Provider Demographics
NPI:1447560065
Name:HOGENMILLER, JETTE ROSHOLM (PHD, MN, ARNP, CDE)
Entity Type:Individual
Prefix:
First Name:JETTE
Middle Name:ROSHOLM
Last Name:HOGENMILLER
Suffix:
Gender:F
Credentials:PHD, MN, ARNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HEALTH PARK DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9584
Mailing Address - Country:US
Mailing Address - Phone:303-661-1860
Mailing Address - Fax:303-661-1861
Practice Address - Street 1:80 HEALTH PARK DR
Practice Address - Street 2:SUITE 270
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9584
Practice Address - Country:US
Practice Address - Phone:303-661-1860
Practice Address - Fax:303-661-1861
Is Sole Proprietor?:No
Enumeration Date:2010-10-16
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110088363LF0000X
IA025803 A099882363LF0000X
WAAP 3000 3517363LF0000X
MO2010009933363LF0000X
WAAP30003517363LF0000X
COC-APN.0100085-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-06671-511Medicaid
NE47-06671-511Medicaid