Basic Information
| Provider Information | |||||||||
| NPI: | 1679098099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIMBERLEY | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | CONSTANTINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801133611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033606276 | ||||||||
| FaxNumber: | 3037612787 | ||||||||
| Practice Location | |||||||||
| Address1: | 15501 E 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033606276 | ||||||||
| FaxNumber: | 3033431006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA2017-0056 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA.0005926 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.