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NPI Code Detail

MEDICARE: JENNIFER WEBERS TETRAULT PA-C

MEDICARE:   JENNIFER WEBERS TETRAULT  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA.0005214CO

General Provider Information

NPI Number : 1083041271
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WEBERS TETRAULT PA-C
Provider Business Mailing Address
First Line : 645 E STATE HIGHWAY 121 STE 600
Second Line :
City : COPPELL
State : TX
Zip : 75019-7942
Country : US
Telephone Number : 972-745-7500
Fax Number : 972-745-4336
Provider Business Practice Location Address
First Line : 7120 E COUNTY LINE RD
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80126-3926
Country : US
Telephone Number : 720-446-5891
Fax Number : 303-220-9688
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2013
Last Update Date : 03/14/2018

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Directions to “ JENNIFER WEBERS TETRAULT PA-C” Practice Location

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