Individual
JENA SULLENBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
559 VINCENT ST., SPACE BASE DELTA 1, PETERSON SPACE FORCE BASE, CO 80914
(719) 556-9858
Mailing address
559 VINCENT ST., SPACE BASE DELTA 1, PETERSON SPACE FORCE BASE, CO 80914
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1636091
CO
Other
Enumeration date
10/15/2025
Last updated
10/15/2025
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