Provider Demographics
NPI:1841000742
Name:HARGIS, JENEFFER (RN)
Entity type:Individual
Prefix:
First Name:JENEFFER
Middle Name:
Last Name:HARGIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 CHANCELLOR DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7143
Mailing Address - Country:US
Mailing Address - Phone:719-271-9973
Mailing Address - Fax:
Practice Address - Street 1:10126 SW PARK WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5008
Practice Address - Country:US
Practice Address - Phone:503-215-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1649308163W00000X
OR202109557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse