Provider Demographics
NPI:1801543962
Name:RAE, JENNIFER MARIE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:RAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50864 COUNTY ROAD 37
Mailing Address - Street 2:
Mailing Address - City:NUNN
Mailing Address - State:CO
Mailing Address - Zip Code:80648-9735
Mailing Address - Country:US
Mailing Address - Phone:970-699-0260
Mailing Address - Fax:
Practice Address - Street 1:50864 COUNTY ROAD 37
Practice Address - Street 2:
Practice Address - City:NUNN
Practice Address - State:CO
Practice Address - Zip Code:80648-9735
Practice Address - Country:US
Practice Address - Phone:970-699-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0203294163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse