Provider Demographics
NPI:1972820504
Name:WIEGAND, ANDREA L (CNM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:WIEGAND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:BULLERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 S PARKER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1622
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160487367A00000X
COAPN.0003408-CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56658028Medicaid
CO021206OtherKAISER COMMERCIAL NUMBER
COCOA103118Medicare PIN