Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 39478 | CO |
NPI | 1003810482 |
---|---|
Provider Name | Dr. Andrea Lynn Weber |
First Address | Conifer, CO 80433-7714 |
Second Address | Conifer, CO 80433-7714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 06/07/2015 |