Provider Demographics
NPI:1427044254
Name:WEIBEL, ANITA ROSE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:ROSE
Last Name:WEIBEL
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 1:538 HUNTINGTON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4154
Mailing Address - Country:US
Mailing Address - Phone:970-226-4154
Mailing Address - Fax:970-226-4154
Practice Address - Street 1:538 HUNTINGTON HILLS DR
Practice Address - Street 2:
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4154
Practice Address - Country:US
Practice Address - Phone:970-226-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9913181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC62756Medicare PIN