MEDICARE: REBECCA ELYSE NIEMEYER PA-C

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	363AM0700X	Medical Physician Assistant	PA.0005522	CO
2	363A00000X	Physician Assistant	PA.0005522	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	452188398	OTHER	CO	COMMERCIAL INSURANCE PLANS
2	PA.0005522	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1275016503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ELYSE NIEMEYER PA-C

Provider Business Mailing Address
First Line	:	2760 29TH ST STE 2B
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-1221
Country	:	US
Telephone Number	:	303-444-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 PRAIRIE CENTER PKWY STE 370
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-4005
Country	:	US
Telephone Number	:	720-401-2139
Fax Number	:	303-469-4439

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	10/09/2025

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