Individual
HALEY RAEANNE WIEDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 NORTH AVE, GRAND JUNCTION, CO 81501-3122
(970) 312-6511
Mailing address
2214 MESA AVE, GRAND JUNCTION, CO 81501-6670
(970) 312-6511
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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