Provider Demographics
NPI:1861539942
Name:RENSNER, JESSICA (CPNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RENSNER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 RIVERGATE # B-109
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7470
Mailing Address - Country:US
Mailing Address - Phone:970-422-8694
Mailing Address - Fax:970-422-8696
Practice Address - Street 1:555 RIVERGATE STE B1-109
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7473
Practice Address - Country:US
Practice Address - Phone:970-422-8694
Practice Address - Fax:970-422-8696
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009264363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics