Provider Demographics
NPI:1437915659
Name:WASECHEK, KYLEE (RN)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:WASECHEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 W 20TH AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-6263
Mailing Address - Country:US
Mailing Address - Phone:719-290-6191
Mailing Address - Fax:
Practice Address - Street 1:7000 W 20TH AVE APT 203
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-6263
Practice Address - Country:US
Practice Address - Phone:719-290-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1645398163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse