Healthcare Provider Details

I. General information

NPI: 1992134621
Provider Name (Legal Business Name): ANNETTE V. WYCHGRAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNETTE V KOZIEL NP

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 E GEDDES AVE SUITE 200
ENGLEWOOD CO
80112-3800
US

IV. Provider business mailing address

10700 E GEDDES AVE SUITE 200
ENGLEWOOD CO
80112-3800
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-9190
  • Fax: 720-874-4462
Mailing address:
  • Phone: 303-761-9190
  • Fax: 720-874-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0990852
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: