Provider Demographics
NPI:1689894875
Name:WEISE, DEBRA KAY (ACUPUNCTURIST)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAY
Last Name:WEISE
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1261
Mailing Address - Street 2:74 SUNDANCE CIRCLE
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-1261
Mailing Address - Country:US
Mailing Address - Phone:303-582-0309
Mailing Address - Fax:
Practice Address - Street 1:2500 30TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1238
Practice Address - Country:US
Practice Address - Phone:720-470-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI086630174400000X
COACU.0002223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO086630Medicaid
CO086630OtherOTR REGISTRATION NUMBER
CO086630OtherOTR REGISTRATION NUMBER
CO086630Medicare UPIN