Provider Demographics
NPI:1922295757
Name:LEIN, JEAN FRYDA (CNM, FNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:FRYDA
Last Name:LEIN
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 COLUMBINE LN
Mailing Address - Street 2:
Mailing Address - City:PARACHUTE
Mailing Address - State:CO
Mailing Address - Zip Code:81635-9553
Mailing Address - Country:US
Mailing Address - Phone:970-314-4409
Mailing Address - Fax:
Practice Address - Street 1:68 COLUMBINE LN
Practice Address - Street 2:
Practice Address - City:PARACHUTE
Practice Address - State:CO
Practice Address - Zip Code:81635-9553
Practice Address - Country:US
Practice Address - Phone:970-314-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91517176B00000X, 163W00000X
CO5885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80238MOtherMEDICARE
TX116287701Medicaid
CO07915176Medicaid
CO71866OtherMEDICARE