Provider Demographics
NPI:1811345473
Name:WEIRICH, ALYSON J (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:J
Last Name:WEIRICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:MOLINA
Mailing Address - State:CO
Mailing Address - Zip Code:81646-0006
Mailing Address - Country:US
Mailing Address - Phone:970-219-8569
Mailing Address - Fax:
Practice Address - Street 1:607 25 RD STE 201
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1287
Practice Address - Country:US
Practice Address - Phone:970-219-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004457363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical