Provider Demographics
NPI:1598063141
Name:WEISS, JENNIFER ALEXUS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALEXUS
Last Name:WEISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 S BROADWAY STE 440
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2624
Mailing Address - Country:US
Mailing Address - Phone:303-795-0890
Mailing Address - Fax:
Practice Address - Street 1:7720 S BROADWAY STE 440
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2624
Practice Address - Country:US
Practice Address - Phone:303-795-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA3144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant