Provider Demographics
NPI:1235403510
Name:WEBSTER, VERA SHANTZ
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:SHANTZ
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
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 410
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-0410
Mailing Address - Country:US
Mailing Address - Phone:303-828-2664
Mailing Address - Fax:303-665-8994
Practice Address - Street 1:1905 MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-9701
Practice Address - Country:US
Practice Address - Phone:303-828-2664
Practice Address - Fax:303-665-8994
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04O500253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care