Provider Demographics
NPI:1730169509
Name:WENZELL, JENNIFER LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:WENZELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:GOTKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:STE 440
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2614
Mailing Address - Country:US
Mailing Address - Phone:719-622-3442
Mailing Address - Fax:719-622-3400
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:STE 440
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2614
Practice Address - Country:US
Practice Address - Phone:719-622-3442
Practice Address - Fax:719-622-3400
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0056409207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30830061Medicaid