Provider Demographics
NPI:1720234990
Name:WIANCEK, DEBORAH A (ND)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:WIANCEK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MAIN ST UNIT C-105
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8501
Mailing Address - Country:US
Mailing Address - Phone:970-926-7606
Mailing Address - Fax:970-926-7606
Practice Address - Street 1:280 MAIN ST UNIT C-105
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-8501
Practice Address - Country:US
Practice Address - Phone:970-926-7606
Practice Address - Fax:970-926-7606
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA846175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA846OtherCONFINITY