Healthcare Provider Details

I. General information

NPI: 1467234815
Provider Name (Legal Business Name): ABIGAIL ESTHER WALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 30TH ST STE 205
BOULDER CO
80301-1236
US

IV. Provider business mailing address

3777 CANFIELD ST APT A203
BOULDER CO
80301-4072
US

V. Phone/Fax

Practice location:
  • Phone: 303-997-8746
  • Fax:
Mailing address:
  • Phone: 406-451-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002841
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: