Provider Demographics
NPI:1144350083
Name:EINWALTER, JENNESSA R
Entity type:Individual
Prefix:
First Name:JENNESSA
Middle Name:R
Last Name:EINWALTER
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 1:2702 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4077
Mailing Address - Country:US
Mailing Address - Phone:917-653-1785
Mailing Address - Fax:
Practice Address - Street 1:2045 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5437
Practice Address - Country:US
Practice Address - Phone:303-831-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171542246XC2901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
017202OtherKAISER-COMMERCIAL NUMBER