Individual
DR. JACLYN NIDERSTADT WAIDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1375 E 20TH AVE, DENVER, CO 80205-5422
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0053985
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024947
KAISER COMMERCIAL NUMBER
CO
05
—
74720384
—
CO
Enumeration date
03/31/2011
Last updated
06/08/2021
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