1952664138 NPI number — DR. MELISSA ROBIN WEISSER AU.D.

Table of content: DR. MELISSA ROBIN WEISSER AU.D. (NPI 1952664138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952664138 NPI number — DR. MELISSA ROBIN WEISSER AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISSER
Provider First Name:
MELISSA
Provider Middle Name:
ROBIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIELSON
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ROBIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952664138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80501-2864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-776-8748
Provider Business Mailing Address Fax Number:
303-684-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80501-2864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-776-8748
Provider Business Practice Location Address Fax Number:
303-684-9915
Provider Enumeration Date:
06/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  648 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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