Healthcare Provider Details

I. General information

NPI: 1275016503
Provider Name (Legal Business Name): REBECCA ELYSE NIEMEYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 PRAIRIE CENTER PKWY STE 370
BRIGHTON CO
80601-4005
US

IV. Provider business mailing address

2760 29TH ST STE 2B
BOULDER CO
80301-1221
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-2139
  • Fax: 303-469-4439
Mailing address:
  • Phone: 303-444-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0005522
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005522
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: