Provider Demographics
NPI:1497899702
Name:WESKAMP, DOMINIC T (FNP)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:T
Last Name:WESKAMP
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2277
Mailing Address - Country:US
Mailing Address - Phone:303-330-0410
Mailing Address - Fax:303-330-0732
Practice Address - Street 1:24300 E SMOKY HILL RD UNIT 120
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1387
Practice Address - Country:US
Practice Address - Phone:303-330-0410
Practice Address - Fax:303-330-0732
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004023277363LF0000X
COC.APN.000269-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427204508Medicaid