Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 182710 | CO |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 655931 | TX |
NPI | 1023025970 |
---|---|
Provider Name | Dr. Mary Therese Weber |
First Address | Aurora, CO 80045 |
Second Address | Thornton, CO 80260-4912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 16/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1551277-01 | (05) | TX |
8N3334 | BCBS (01) | TX |
S85315 | (02) | TX |