Provider Demographics
NPI:1679659312
Name:WHALEN, JENNIFER M (CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WHALEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 CROWN CREST BLVD STE 200INTEG
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8882
Mailing Address - Country:US
Mailing Address - Phone:303-721-1670
Mailing Address - Fax:303-721-8117
Practice Address - Street 1:9403 CROWN CREST BLVD STE 200INTEG
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8882
Practice Address - Country:US
Practice Address - Phone:303-721-1670
Practice Address - Fax:303-721-8117
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0005094-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38989514Medicaid
CO16795931Medicaid
CO38989514Medicaid