Provider Demographics
NPI:1821231333
Name:HJELT, JEANINE CATHERINE
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:CATHERINE
Last Name:HJELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:CATHERINE
Other - Last Name:POPLAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6767 29TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5474
Mailing Address - Country:US
Mailing Address - Phone:970-224-9102
Mailing Address - Fax:970-224-9112
Practice Address - Street 1:6767 29TH ST FL 2
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5474
Practice Address - Country:US
Practice Address - Phone:970-224-9102
Practice Address - Fax:970-224-9112
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4342363AM0700X
WYPA889363AM0700X
COPA.0005289363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000158652Medicaid