Provider Demographics
NPI:1689412645
Name:ENSMENGER, CARLA JEANNE
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JEANNE
Last Name:ENSMENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:ENSMENGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:9669 SPRUCE MOUNTAIN RD LOT 14
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CO
Mailing Address - Zip Code:80118-1200
Mailing Address - Country:US
Mailing Address - Phone:720-427-5228
Mailing Address - Fax:
Practice Address - Street 1:1189 S PERRY ST STE 230
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1959
Practice Address - Country:US
Practice Address - Phone:303-688-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999845-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily