Provider Demographics
NPI:1043350705
Name:WOERNER, DAWN R (PA)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:R
Last Name:WOERNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:RIEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:970-225-5000
Mailing Address - Fax:
Practice Address - Street 1:9251 TWENTY MILE ROAD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:970-225-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2285363AM0700X
COPA.0002285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO363A00000XMedicaid
CO2285OtherCO STATE PA LICENSE