Provider Demographics
NPI:1346325099
Name:WIGHTMAN, CLARE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:WIGHTMAN
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4209
Mailing Address - Country:US
Mailing Address - Phone:720-290-4200
Mailing Address - Fax:
Practice Address - Street 1:488 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4209
Practice Address - Country:US
Practice Address - Phone:720-290-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2184363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29584779Medicaid
CO29584779Medicaid
Q64018Medicare UPIN