MEDICARE: SARAH RACHEL WESSELIUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.1677377	CO
2	163W00000X	Registered Nurse	893194	TX
3	363LF0000X	Family Nurse Practitioner	1046062	TX
4	363LF0000X	Family Nurse Practitioner	APN.0996959-NP	CO

General Provider Information

NPI Number	:	1336728609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RACHEL WESSELIUS

Provider Business Mailing Address
First Line	:	11439 JAMAICA ST
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80640-7662
Country	:	US
Telephone Number	:	214-364-7751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 PRAIRIE CENTER PKWY STE 270
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-4005
Country	:	US
Telephone Number	:	303-498-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	10/19/2021

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