Provider Demographics
NPI:1134094055
Name:ELLISTON, JESINA A
Entity type:Individual
Prefix:
First Name:JESINA
Middle Name:A
Last Name:ELLISTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 POTOMAC CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6714
Mailing Address - Country:US
Mailing Address - Phone:720-752-1786
Mailing Address - Fax:
Practice Address - Street 1:860 POTOMAC CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6714
Practice Address - Country:US
Practice Address - Phone:720-752-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1660260163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics