Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 77745 | CO |
N | 363LC1500X | Nurse Practitioner - Community Health | 77745 | CO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 77745 | CO |
N | 363LG0600X | Nurse Practitioner - Gerontology | 77745 | CO |
N | 363LP2300X | Nurse Practitioner - Primary Care | 77745 | CO |
NPI | 1447283064 |
---|---|
Provider Name | Ms. Kimberley Elizabeth Wengrove |
First Address | Arvada, CO 80005-3441 |
Second Address | Denver, CO 80220-3808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 08/07/2007 |