Healthcare Provider Details

I. General information

NPI: 1598063141
Provider Name (Legal Business Name): JENNIFER ALEXUS WEISS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 S BROADWAY STE 440
LITTLETON CO
80122-2624
US

IV. Provider business mailing address

7720 S BROADWAY STE 440
LITTLETON CO
80122-2624
US

V. Phone/Fax

Practice location:
  • Phone: 303-795-0890
  • Fax:
Mailing address:
  • Phone: 303-795-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3144
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: