Provider Demographics
NPI:1144273475
Name:STAPLETON, WENDY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANNE
Other - Last Name:JACOBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:STE 205
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-385-7272
Mailing Address - Fax:970-385-7299
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:STE 205
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-385-7272
Practice Address - Fax:970-385-7299
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC69158Medicare PIN