Individual
BROOKE NICOLE DEWEESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
121 S. CRESCENT DRIVE, PUEBLO WEST, CO 81007-5433
(719) 595-7575
(719) 288-2799
Mailing address
PO BOX 560825, DENVER, CO 80256-0825
(719) 595-7580
(719) 545-0176
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.0003584
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89056779
—
CO
Enumeration date
11/15/2012
Last updated
03/02/2016
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