Provider Demographics
NPI:1730482811
Name:VIERTHALER, JENNIFER (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VIERTHALER
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 1:8301 E PRENTICE AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2989
Mailing Address - Country:US
Mailing Address - Phone:303-771-3939
Mailing Address - Fax:303-771-4949
Practice Address - Street 1:8301 E PRENTICE AVE STE 125
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2989
Practice Address - Country:US
Practice Address - Phone:303-771-3939
Practice Address - Fax:303-771-4949
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant