Individual
KELLY WIECHERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
600 SOUTH DR, FORT COLLINS, CO 80523-0001
(970) 491-7121
Mailing address
600 SOUTH DR, FORT COLLINS, CO 80523-0001
(970) 491-7121
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
175410
CO
Other
Enumeration date
04/29/2010
Last updated
05/13/2011
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