Provider Demographics
NPI:1700034980
Name:WEINSTEIN, BROOKE CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:CHRISTINE
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST E101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1872
Mailing Address - Country:US
Mailing Address - Phone:970-493-5334
Mailing Address - Fax:970-472-0638
Practice Address - Street 1:2001 S SHIELDS ST E101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1872
Practice Address - Country:US
Practice Address - Phone:970-493-5334
Practice Address - Fax:970-472-0638
Is Sole Proprietor?:No
Enumeration Date:2008-08-30
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00817671OtherRAILROAD MEDICARE
CO14185237Medicaid
1082554OtherNCCPA ID
CO2650OtherSTATE LICENSE
COP00817671OtherRAILROAD MEDICARE