Provider Demographics
NPI:1275016503
Name:NIEMEYER, REBECCA ELYSE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELYSE
Last Name:NIEMEYER
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 1:1606 PRAIRIE CENTER PKWY STE 370
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4005
Mailing Address - Country:US
Mailing Address - Phone:720-401-2139
Mailing Address - Fax:303-469-4439
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY STE 370
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4005
Practice Address - Country:US
Practice Address - Phone:720-401-2139
Practice Address - Fax:303-469-4439
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005522363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO452188398OtherCOMMERCIAL INSURANCE PLANS
COPA.0005522OtherSTATE LICENSE