Healthcare Provider Details

I. General information

NPI: 1891324786
Provider Name (Legal Business Name): REBECCA WYLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 W 29TH AVE # 80211
DENVER CO
80211-3712
US

IV. Provider business mailing address

732 BOWEN ST
LONGMONT CO
80501-4414
US

V. Phone/Fax

Practice location:
  • Phone: 303-349-3835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002539
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: