Provider Demographics
NPI:1497194211
Name:WILSON, DUANDELYN CLAUDETTE (NP)
Entity Type:Individual
Prefix:
First Name:DUANDELYN
Middle Name:CLAUDETTE
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DUANDELYN
Other - Middle Name:
Other - Last Name:CHATTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:499 E HAMPDEN AVE STE 380
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3877
Practice Address - Country:US
Practice Address - Phone:720-493-3345
Practice Address - Fax:720-874-4437
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0175186363LN0000X
CO0990859363L00000X
COAPN.0990859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO384572YQN9OtherMEDICARE PTAN
CO384572YQ3LOtherMEDICARE PTAN
CO81434281Medicaid
CO588366YQ3LOtherMEDICARE PIN
CO384572YQPGOtherMEDICARE PTAN