Individual
JAMIE HERGENREDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1637 29TH AVENUE PL, GREELEY, CO 80634-6822
(970) 356-8181
Mailing address
1637 29TH AVENUE PL, GREELEY, CO 80634-6822
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0013645
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0013645
—
CO
Enumeration date
08/27/2019
Last updated
08/27/2019
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