Provider Demographics
NPI:1568174068
Name:WAIS, AMY (LAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WAIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:QUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1257
Mailing Address - Country:US
Mailing Address - Phone:970-901-2619
Mailing Address - Fax:
Practice Address - Street 1:503 RED LADY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-901-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002424171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist