Wagner, Penelope Andrea

Wagner, Penelope Andrea is an individual health care provider with primary practice located at 5920 Mcintyre St , Golden CO 80403-7445. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Wagner, Penelope Andrea can be contacted via phone (303) 949-1250.

Contact Information

Primary practice address
5920 Mcintyre St Golden CO 80403-7445
Phone: (303) 949-1250
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Gerontology 163WG0600X RN-75898 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 5547 Colorado

Profile Details

NPI number 1164608477
LBN Legal business name Wagner, Penelope Andrea
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 16th, 2008
Last updated Jan 22nd, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164608477 NPPES
Colorado MEDICAID 60500034

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