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NPI Code Detail

MEDICARE: WENDY BROKKEN

MEDICARE:   WENDY  BROKKEN
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
1124Q00000XDental Hygienist905286CO

General Provider Information

NPI Number : 1396959649
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY BROKKEN
Provider Business Mailing Address
First Line : 3996 RED CEDAR DR
Second Line : STE A-3
City : HIGHLANDS RANCH
State : CO
Zip : 80126-8065
Country : US
Telephone Number : 303-470-9696
Fax Number :
Provider Business Practice Location Address
First Line : 3996 RED CEDAR DR
Second Line : STE A-3
City : HIGHLANDS RANCH
State : CO
Zip : 80126-8065
Country : US
Telephone Number : 303-470-9696
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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