Provider Demographics
NPI:1003965203
Name:ORTIZ, WENDY RENEE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:RENEE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:RENEE
Other - Last Name:SUCHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:10359 N FEDERAL BOULEVARD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-7453
Mailing Address - Country:US
Mailing Address - Phone:303-289-1928
Mailing Address - Fax:303-404-2828
Practice Address - Street 1:10359 FEDERAL BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80260-7452
Practice Address - Country:US
Practice Address - Phone:303-404-0200
Practice Address - Fax:303-404-2828
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1604363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ07027Medicare UPIN
COC807871Medicare PIN