Provider Demographics
NPI:1841837382
Name:WIEDMAN, BROOKE (NP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WIEDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:PFRETZSCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1735 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1683
Mailing Address - Country:US
Mailing Address - Phone:303-915-2938
Mailing Address - Fax:
Practice Address - Street 1:1735 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1683
Practice Address - Country:US
Practice Address - Phone:303-915-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995103-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics