Provider Demographics
NPI:1295031714
Name:WEISENBORN, KATHERINE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:M
Last Name:WEISENBORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9005 GRANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4300
Mailing Address - Country:US
Mailing Address - Phone:303-287-2800
Mailing Address - Fax:303-287-7357
Practice Address - Street 1:9005 GRANT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4300
Practice Address - Country:US
Practice Address - Phone:303-287-2800
Practice Address - Fax:303-287-7357
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2010-0079363AM0700X
COPA0003838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical