Provider Demographics
NPI:1386953826
Name:WOLD, JENNIFER RENEE (PAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENEE
Last Name:WOLD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1960 N OGDEN ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3666
Mailing Address - Country:US
Mailing Address - Phone:303-318-3214
Mailing Address - Fax:303-673-1330
Practice Address - Street 1:1960 N OGDEN ST
Practice Address - Street 2:SUITE 520
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:303-318-3214
Practice Address - Fax:303-673-1330
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA0004443363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant