Provider Demographics
NPI:1649444951
Name:WERTKIN, AVIVA D (ND NATUROPATHIC DOCT)
Entity type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:D
Last Name:WERTKIN
Suffix:
Gender:F
Credentials:ND NATUROPATHIC DOCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 PARK LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3172
Mailing Address - Country:US
Mailing Address - Phone:203-640-7319
Mailing Address - Fax:303-872-4259
Practice Address - Street 1:2581 PARK LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3172
Practice Address - Country:US
Practice Address - Phone:303-775-3198
Practice Address - Fax:303-872-4259
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT384175F00000X
VT099.0100226175F00000X, 207Q00000X
COND.0000250175F00000X
MENP624208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No175F00000XOther Service ProvidersNaturopath
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110000384CT01OtherANTHEM BLUE CROSS
11805577OtherCAQH NUMBER
VT00075857OtherBLUE CROSS BLUE SHIELD OF VT
11805577OtherCAQH NUMBER
11805577OtherCAQH NUMBER