Provider Demographics
NPI:1619520426
Name:WEKENMANN, CALEY
Entity type:Individual
Prefix:
First Name:CALEY
Middle Name:
Last Name:WEKENMANN
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 1:2525 ARAPAHOE AVE UNIT E4
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6746
Mailing Address - Country:US
Mailing Address - Phone:716-480-3106
Mailing Address - Fax:
Practice Address - Street 1:275 PROMENADE DR UNIT 106
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-1782
Practice Address - Country:US
Practice Address - Phone:716-480-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402760363LP0808X
COAPN.0998175-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health