Individual
MRS. JAN GILLESPIE-WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1175 58TH AVE, STE 200, GREELEY, CO 80634-4807
(970) 495-0444
(970) 488-3106
Mailing address
1175 58TH AVE, STE 202, GREELEY, CO 80634-4807
(970) 495-0300
(970) 224-9624
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
26768
CO
208VP0014X
Interventional Pain Medicine Physician
Primary
26768
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01267681
—
CO
05
—
102189300
—
WY
01
—
187075800
DEPARTMENT OF LABOR
—
01
—
GI160818
ANTHEM BCBS
CO
Enumeration date
11/23/2005
Last updated
11/30/2020
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