Provider Demographics
NPI:1477901304
Name:WEGERT, ABIGAIL L (NP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:L
Last Name:WEGERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-744-3477
Mailing Address - Fax:303-733-5848
Practice Address - Street 1:8015 W ALAMEDA AVE STE 260
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-744-3477
Practice Address - Fax:303-733-5848
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1639869163W00000X
CO992471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14135060Medicaid
CO14135060Medicaid