Provider Demographics
NPI:1720364771
Name:DREYER, ELISABETH NICHOLE (LAC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:NICHOLE
Last Name:DREYER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S SPRING ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2067
Mailing Address - Country:US
Mailing Address - Phone:970-618-6198
Mailing Address - Fax:
Practice Address - Street 1:100 S SPRING ST STE 5
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-2067
Practice Address - Country:US
Practice Address - Phone:970-618-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist