Provider Demographics
NPI:1093427536
Name:WIESINGER, BETTINA (CPM, RM)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:
Last Name:WIESINGER
Suffix:
Gender:F
Credentials:CPM, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19705 CLUBHOUSE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-6247
Mailing Address - Country:US
Mailing Address - Phone:720-687-6086
Mailing Address - Fax:
Practice Address - Street 1:19705 CLUBHOUSE DR APT 102
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-6247
Practice Address - Country:US
Practice Address - Phone:720-687-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMWR0000221176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife