Provider Demographics
NPI:1003423591
Name:WEDERSKI, KRISTEN KAYE (DOCTORAL STUDENT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KAYE
Last Name:WEDERSKI
Suffix:
Gender:F
Credentials:DOCTORAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7476 E ARKANSAS AVE APT 505
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2561
Mailing Address - Country:US
Mailing Address - Phone:307-840-0216
Mailing Address - Fax:
Practice Address - Street 1:2450 S VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5264
Practice Address - Country:US
Practice Address - Phone:617-329-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program