Provider Demographics
NPI:1497871198
Name:JENSEN, RUTH H (FNP-C)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:H
Last Name:JENSEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:H
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1800 15TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4500
Mailing Address - Country:US
Mailing Address - Phone:970-378-4558
Mailing Address - Fax:970-350-6965
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4500
Practice Address - Country:US
Practice Address - Phone:970-378-4558
Practice Address - Fax:970-350-6965
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-174652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO174652OtherSTATE LICENSE NUMBER
CO13551281Medicaid
COMD0382818OtherDEA
COQ65144Medicare UPIN
CO13551281Medicaid