Provider Demographics
NPI:1467234815
Name:WALES, ABIGAIL ESTHER
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ESTHER
Last Name:WALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 CANFIELD ST APT A203
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-4072
Mailing Address - Country:US
Mailing Address - Phone:406-451-8277
Mailing Address - Fax:
Practice Address - Street 1:2500 30TH ST STE 205
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1236
Practice Address - Country:US
Practice Address - Phone:303-997-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002841171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist