Provider Demographics
NPI:1457010274
Name:WEIR, RONDA GAIL (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:GAIL
Last Name:WEIR
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:GAIL
Other - Last Name:HUMISTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:106 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3749
Mailing Address - Country:US
Mailing Address - Phone:970-564-7171
Mailing Address - Fax:
Practice Address - Street 1:106 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3749
Practice Address - Country:US
Practice Address - Phone:970-564-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997214-NP207Q00000X, 363LP2300X, 363LF0000X
CORN.0107385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0997214-NPOtherCO DORA
CO9000202304Medicaid