Basic Information
| Provider Information | |||||||||
| NPI: | 1770978439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERSSON | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13123 E 16TH AVE # 100 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800457106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207772940 | ||||||||
| FaxNumber: | 7207777290 | ||||||||
| Practice Location | |||||||||
| Address1: | 13001 E. 17TH PLACE | ||||||||
| Address2: | UNIVERSITY OF COLORADO SCHOOL OF MEDICINE GME | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207773846 | ||||||||
| FaxNumber: | 7207777258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.