Individual
JACQUELYN CORRERO STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1236 E ELIZABETH ST, SUITE 1, FORT COLLINS, CO 80524-4000
(970) 224-2985
(970) 472-9381
Mailing address
1236 E ELIZABETH ST, SUITE 1, FORT COLLINS, CO 80524-4000
(970) 224-2985
(970) 472-9381
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
SRA-100065
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31432514
—
CO
01
—
P01080542
CO MEDICARE RR
CO
Enumeration date
01/13/2012
Last updated
06/19/2013
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