MEDICARE: DR. ELIZABETH ANNE WUERSLIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	31325	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30325	OTHER	CO	MD LICENSE

General Provider Information

NPI Number	:	1366550154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANNE WUERSLIN MD

Provider Business Mailing Address
First Line	:	1524 ROLF CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1220
Country	:	US
Telephone Number	:	970-494-1336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 ROLF CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1220
Country	:	US
Telephone Number	:	970-494-1336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	02/27/2008

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