Provider Demographics
NPI:1144324500
Name:WILDER, KAREN L (P-AC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:WILDER
Suffix:
Gender:F
Credentials:P-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-861-4845
Mailing Address - Fax:303-861-4842
Practice Address - Street 1:1601 E 19TH AVE STE 5050
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1200
Practice Address - Country:US
Practice Address - Phone:720-754-2155
Practice Address - Fax:720-754-2106
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP2034Medicare PIN
Q03350Medicare UPIN