Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | A119948 | IA |
Y | 363L00000X | Nurse Practitioner | C-APN-0000207-C-NP | CO |
NPI | 1003240771 |
---|---|
Provider Name | Casey Marie Weller |
First Address | Denver, CO 80291-2215 |
Second Address | Fort Collins, CO 80524-3929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31701230 | (05) | CO |