Provider Demographics
NPI:1659515658
Name:OLANDER, JESSICA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:OLANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MOENNICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1056 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9460
Mailing Address - Country:US
Mailing Address - Phone:303-442-6647
Mailing Address - Fax:303-442-2696
Practice Address - Street 1:905 W 124TH AVE STE 170
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1716
Practice Address - Country:US
Practice Address - Phone:303-442-6647
Practice Address - Fax:303-442-2696
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52384207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO023016OtherKAISER COMMERCIAL NUMBER
CO12606243Medicaid
CO023016OtherKAISER COMMERCIAL NUMBER