Provider Demographics
NPI:1285209809
Name:WIMBERGER, LISA (MED)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WIMBERGER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 N GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5530
Mailing Address - Country:US
Mailing Address - Phone:303-981-9743
Mailing Address - Fax:
Practice Address - Street 1:1245 E COLFAX AVE STE 207
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2210
Practice Address - Country:US
Practice Address - Phone:303-981-9743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
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