Provider Demographics
NPI:1386040111
Name:WOHLGEMUTH, JESSIKA JACOBS (RN)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:JACOBS
Last Name:WOHLGEMUTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:KYRIA
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14701 E EXPOSITION AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2623
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:14701 E EXPOSITION AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2623
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0196218163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN.0196218OtherNURSING CREDENTIAL- COLORADO NURSING LICENSE