Healthcare Provider Details

I. General information

NPI: 1881929065
Provider Name (Legal Business Name): JESSICA LEE WEGENER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 07/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 HUMBOLDT ST
DENVER CO
80218-1614
US

IV. Provider business mailing address

495 W FREMONT DR
LITTLETON CO
80120-4246
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-1650
  • Fax:
Mailing address:
  • Phone: 720-563-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: