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General NPI Number Information
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NPI Number | 1154702520
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Entity Type | Individual
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Provider Name | JENNA WEISBERG
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 7290 W 14TH AVE
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City | LAKEWOOD
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State | CO
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Zip | 80214-4725
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Country | US
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Telephone | 303-232-8047
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Fax | 303-232-1979
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Provider Business Mailing Address
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Address Line | 4851 INDEPENDENCE ST SUITE 200
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-6715
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Country | US
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Telephone | 303-425-0300
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Fax | 303-432-5071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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