Provider Demographics
NPI:1902550478
Name:VANDENBURG, JESSE CREE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:CREE
Last Name:VANDENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 CLIFFROSE WAY
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2944
Mailing Address - Country:US
Mailing Address - Phone:307-421-8859
Mailing Address - Fax:
Practice Address - Street 1:1817 JESSUP DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2550
Practice Address - Country:US
Practice Address - Phone:866-218-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula