Provider Demographics
NPI:1801831441
Name:ENSIGN, JUDITH EILEEN (APRN)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:EILEEN
Last Name:ENSIGN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4057 W 62ND PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-6713
Mailing Address - Country:US
Mailing Address - Phone:303-429-9115
Mailing Address - Fax:303-429-9115
Practice Address - Street 1:60 W BROMLEY LN
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3026
Practice Address - Country:US
Practice Address - Phone:303-637-0860
Practice Address - Fax:303-637-0890
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43030360Medicaid
CO43030360Medicaid