Basic Information
| Provider Information | |||||||||
| NPI: | 1154705135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLANSKI | ||||||||
| FirstName: | TERESA | ||||||||
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| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2763 DHARMA AVE | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800205480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087450172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2055 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033019019 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2015 | ||||||||
| LastUpdateDate: | 03/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 041385993 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | APN.0993020-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.