Provider Demographics
NPI:1992451249
Name:SENERICHES, JAN KRISTY COLANZE
Entity type:Individual
Prefix:
First Name:JAN KRISTY
Middle Name:COLANZE
Last Name:SENERICHES
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 1:400 NELSON AVE APT 1105
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-3335
Mailing Address - Country:US
Mailing Address - Phone:505-436-9688
Mailing Address - Fax:
Practice Address - Street 1:400 NELSON AVE APT 1105
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-3335
Practice Address - Country:US
Practice Address - Phone:505-436-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-84262163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1132003Medicaid