Provider Demographics
NPI:1346820495
Name:WEINBERGER, BROOKE KITTINGER
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:KITTINGER
Last Name:WEINBERGER
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 1:1140 W SOUTH BOULDER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8910
Mailing Address - Country:US
Mailing Address - Phone:303-604-1444
Mailing Address - Fax:
Practice Address - Street 1:1140 W SOUTH BOULDER RD STE 202
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8910
Practice Address - Country:US
Practice Address - Phone:303-604-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty