Healthcare Provider Details

I. General information

NPI: 1295236677
Provider Name (Legal Business Name): STEPHANIE GOMOLKA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26659 PLEASANT PARK RD
CONIFER CO
80433-7768
US

IV. Provider business mailing address

26659 PLEASANT PARK RD
CONIFER CO
80433-7768
US

V. Phone/Fax

Practice location:
  • Phone: 303-647-5300
  • Fax: 877-892-7288
Mailing address:
  • Phone: 303-647-5300
  • Fax: 877-892-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005273
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: