Provider Demographics
NPI:1588134894
Name:WYTTENBACH, STEPHANIE ANNE (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:WYTTENBACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 HALE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4025
Mailing Address - Country:US
Mailing Address - Phone:720-328-5151
Mailing Address - Fax:720-524-4336
Practice Address - Street 1:4700 HALE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4025
Practice Address - Country:US
Practice Address - Phone:720-328-5151
Practice Address - Fax:720-524-4336
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0171715363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner