Provider Demographics
NPI:1740406909
Name:SUCHON, JENNIFER E (CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:SUCHON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:DANIELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-497-8416
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:528 N. UNCOMPAHGRE AVE.
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3831
Practice Address - Country:US
Practice Address - Phone:970-240-6438
Practice Address - Fax:970-249-8902
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167305363LP0200X
COAPN.0005776-NP363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88726762Medicaid