NPI 1063779072 · live from the CMS NPI Registry
Jennifer Michelle Divine, MD
Dermatology, MOHS-Micrographic Surgery in Fort Collins, CO. National Provider Identifier 1063779072, active.
NPI record
| NPI | 1063779072 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dermatology, MOHS-Micrographic Surgery 207ND0101X |
| Practice location | 1260 Doctor'S Lane, Fort Collins, CO 80524 |
| Practice phone | 970-286-2668 |
| Enumerated | April 15, 2012 |
| Last updated | July 19, 2024 |
| Sole proprietor | Yes |
| Other names | Jennifer Corbin |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | ME 131766 (FL) |
| Dermatology, MOHS-Micrographic Surgery primary | 207ND0101X | DR.0058205 (CO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.