Provider Demographics
NPI:1831848134
Name:WIGGLESWORTH, KELLY RACHEL STANEK (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RACHEL STANEK
Last Name:WIGGLESWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:RACHEL
Other - Last Name:STANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13001 E 17TH PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2570
Mailing Address - Country:US
Mailing Address - Phone:720-777-3846
Mailing Address - Fax:720-777-7258
Practice Address - Street 1:13001 E 17TH PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2570
Practice Address - Country:US
Practice Address - Phone:720-777-3846
Practice Address - Fax:720-777-7258
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program