Individual
JENNIFER MICHELLE DIVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1260 DOCTOR'S LANE, FORT COLLINS, CO 80524
(970) 286-2668
(970) 294-4954
Mailing address
1260 DOCTOR'S LANE, FORT COLLINS, CO 80524
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
DR.0058205
CO
207ND0101X
MOHS-Micrographic Surgery Physician
ME 131766
FL
Other
Enumeration date
04/15/2012
Last updated
07/19/2024
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