Individual
JENNA WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26433 CR GG, ROCKY FORD, CO 81067-8106
(719) 999-9999
Mailing address
1120 E 3RD ST, LA JUNTA, CO 81050-1906
(719) 363-1514
(719) 468-2427
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0991101
CO
Other
Enumeration date
03/19/2014
Last updated
10/13/2020
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