Basic Information
| Provider Information | |||||||||
| NPI: | 1639412356 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WENZEL | ||||||||
| FirstName: | MAUREEN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 S MONACO ST | ||||||||
| Address2: | #210 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802373486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035349550 | ||||||||
| FaxNumber: | 7209327805 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 WAZEE ST | ||||||||
| Address2: | UNIT D | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802021478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035349550 | ||||||||
| FaxNumber: | 7209327805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 01/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 990440 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 68730063 | 05 | CO | MEDICAID |