Provider Demographics
NPI:1851751333
Name:JENNINGS, CHARLENE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W DRY CREEK CIR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4478
Mailing Address - Country:US
Mailing Address - Phone:303-482-2966
Mailing Address - Fax:
Practice Address - Street 1:20 W DRY CREEK CIR
Practice Address - Street 2:SUITE 310
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4478
Practice Address - Country:US
Practice Address - Phone:303-482-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992192-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology