MEDICARE: WOVEN PEDIATRICS PLLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1699493692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOVEN PEDIATRICS PLLC

Provider Business Mailing Address
First Line	:	130 S LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-2522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 S LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-2522
Country	:	US
Telephone Number	:	917-601-3169
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	STEPHANIE DUNN
Credential	:	MD
Telephone Number	:	917-601-3169

Provider Enumeration Date	:	08/16/2022
Last Update Date	:	08/16/2022

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