Healthcare Provider Details

I. General information

NPI: 1205585510
Provider Name (Legal Business Name): BLAIR KATELYN WERNICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DOWNING ST
DENVER CO
80210-5855
US

IV. Provider business mailing address

3381 S WABASH CT
DENVER CO
80231-4524
US

V. Phone/Fax

Practice location:
  • Phone: 303-316-6677
  • Fax:
Mailing address:
  • Phone: 405-819-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN.0997448-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: