Provider Demographics
NPI:1093059560
Name:WEIDMANN WALTER, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WEIDMANN WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N COLLEGE AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4427
Mailing Address - Country:US
Mailing Address - Phone:970-690-1990
Mailing Address - Fax:970-493-4793
Practice Address - Street 1:123 N COLLEGE AVE
Practice Address - Street 2:STE. 200
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4427
Practice Address - Country:US
Practice Address - Phone:970-690-1990
Practice Address - Fax:970-493-4793
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath