Provider Demographics
NPI:1912127606
Name:WIMMER, LINDSEY JEAN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:JEAN
Last Name:WIMMER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:JEAN
Other - Last Name:LIBSACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10216 DUSK ST
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504
Mailing Address - Country:US
Mailing Address - Phone:303-833-3305
Mailing Address - Fax:
Practice Address - Street 1:3655 LUTHERAN PKWY
Practice Address - Street 2:SUITE 300A
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:720-284-3700
Practice Address - Fax:303-467-0525
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO122842208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29655358Medicaid