Provider Demographics
NPI:1952404345
Name:OOMKES, JOANNA M-WOJTOWICZ (PA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M-WOJTOWICZ
Last Name:OOMKES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:M
Other - Last Name:WOJTOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1960 OGDEN ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3666
Mailing Address - Country:US
Mailing Address - Phone:303-318-2440
Mailing Address - Fax:303-318-2485
Practice Address - Street 1:1960 OGDEN ST
Practice Address - Street 2:SUITE 540
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:303-318-2440
Practice Address - Fax:303-318-2485
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA-2783363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24929565Medicaid
COCOA105151Medicare PIN