Healthcare Provider Details

I. General information

NPI: 1922992767
Provider Name (Legal Business Name): CAROLYN CLEMONS WESOLOSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 W COLFAX AVE
LAKEWOOD CO
80215-3918
US

IV. Provider business mailing address

9485 W COLFAX AVE
LAKEWOOD CO
80215-3918
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-0300
  • Fax:
Mailing address:
  • Phone: 303-425-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN1703299
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: