Healthcare Provider Details

I. General information

NPI: 1720669542
Provider Name (Legal Business Name): JOHANNA THOMPSON-WESTRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 S FEDERAL BLVD
DENVER CO
80219-4235
US

IV. Provider business mailing address

1339 S FEDERAL BLVD
DENVER CO
80219-4235
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0008588
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0073665
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: