Provider Demographics
NPI:1104956960
Name:WYRICK, JANET D
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:D
Last Name:WYRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 HACKNEY CT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5310
Mailing Address - Country:US
Mailing Address - Phone:720-842-5461
Mailing Address - Fax:
Practice Address - Street 1:9285 HEPBURN ST
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2262
Practice Address - Country:US
Practice Address - Phone:720-348-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171714207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
016864OtherKAISER-COMMERCIAL NUMBER