Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | DR.0038548 | CO |
Y | 208600000X | Surgeon | DR.0038548 | CO |
NPI | 1003923301 |
---|---|
Provider Name | Dr. Rebecca L Wiebe |
First Address | Wheat Ridge, CO 80033-6021 |
Second Address | Wheat Ridge, CO 80033-6021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 03/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020047061 | MEDICARE RR (01) | CO |
46936084 | (05) | CO |
G09582 | (02) | CO |