Provider Demographics
NPI:1801296348
Name:WENZEL, KATIE ANN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ANN
Last Name:WENZEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:WENZEL
Other - Last Name:VECCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1406
Mailing Address - Country:US
Mailing Address - Phone:720-745-8030
Mailing Address - Fax:720-745-8031
Practice Address - Street 1:2101 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1406
Practice Address - Country:US
Practice Address - Phone:720-745-8030
Practice Address - Fax:720-745-8031
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0175182163W00000X
COAPN.0991914-NP363L00000X, 363LF0000X
WY34182.1340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01730061Medicaid