Healthcare Provider Details

I. General information

NPI: 1295031714
Provider Name (Legal Business Name): KATHERINE M. WEISENBORN P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 GRANT ST SUITE 200
THORNTON CO
80229-4300
US

IV. Provider business mailing address

9005 GRANT ST SUITE 200
THORNTON CO
80229-4300
US

V. Phone/Fax

Practice location:
  • Phone: 303-287-2800
  • Fax: 303-287-7357
Mailing address:
  • Phone: 303-287-2800
  • Fax: 303-287-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2010-0079
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0003838
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: