Healthcare Provider Details

I. General information

NPI: 1003240771
Provider Name (Legal Business Name): CASEY MARIE WELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASEY M. PANKO ARNP

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2100
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-1900
  • Fax: 970-624-2192
Mailing address:
  • Phone: 970-624-4439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA119948
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992488-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: