Provider Demographics
NPI:1720364771
Name:DREYER, ELISABETH NICHOLE (LAC)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:NICHOLE
Last Name:DREYER
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5532 LILLEHAMMER LN STE 102
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6078
Mailing Address - Country:US
Mailing Address - Phone:970-618-4788
Mailing Address - Fax:
Practice Address - Street 1:5532 LILLEHAMMER LN STE 102
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6078
Practice Address - Country:US
Practice Address - Phone:970-618-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1625171100000X
UT10358219-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist