Provider Demographics
NPI:1124212568
Name:KRUSE, JENIFER R (MS, RDN, CDCES, CPT)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:R
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MS, RDN, CDCES, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 BEARD CREEK RD
Mailing Address - Street 2:STE 1300
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-6433
Mailing Address - Country:US
Mailing Address - Phone:765-838-8044
Mailing Address - Fax:765-838-8136
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered