Provider Demographics
NPI:1760928204
Name:JESBERGER, JANEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:
Last Name:JESBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 N UNION BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-1907
Mailing Address - Country:US
Mailing Address - Phone:719-694-3595
Mailing Address - Fax:719-493-9936
Practice Address - Street 1:3920 N UNION BLVD STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-1907
Practice Address - Country:US
Practice Address - Phone:719-694-3595
Practice Address - Fax:719-493-9936
Is Sole Proprietor?:No
Enumeration Date:2017-01-08
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058684363AM0700X
COPA.0007778363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical