Provider Demographics
NPI:1295770675
Name:WEDEL, JOELLE SELKIN (PAC)
Entity type:Individual
Prefix:MS
First Name:JOELLE
Middle Name:SELKIN
Last Name:WEDEL
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:5161 E ARAPAHOE RD
Mailing Address - Street 2:#290
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:720-488-0055
Mailing Address - Fax:720-488-3955
Practice Address - Street 1:5161 E ARAPAHOE RD
Practice Address - Street 2:#290
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:720-488-0055
Practice Address - Fax:720-488-3955
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO818363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63330563Medicaid
CO800160Medicare ID - Type Unspecified
S86167Medicare UPIN