Provider Demographics
NPI:1710051784
Name:JESSUP, JENNIFER L
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:JESSUP
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JIANWEI
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:324 E UINTAH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2410
Mailing Address - Country:US
Mailing Address - Phone:719-634-6863
Mailing Address - Fax:719-520-9240
Practice Address - Street 1:324 E UINTAH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2410
Practice Address - Country:US
Practice Address - Phone:719-634-6863
Practice Address - Fax:719-520-9240
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist