Provider Demographics
NPI:1336728609
Name:WESSELIUS, SARAH RACHEL
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RACHEL
Last Name:WESSELIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11439 JAMAICA ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80640-7662
Mailing Address - Country:US
Mailing Address - Phone:214-364-7751
Mailing Address - Fax:
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY STE 270
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4005
Practice Address - Country:US
Practice Address - Phone:303-498-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1677377163W00000X
TX893194163W00000X
TX1046062363LF0000X
COAPN.0996959-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse