Provider Demographics
NPI:1134226640
Name:WEIS-FOUT, MARY C (MSN FNP C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:WEIS-FOUT
Suffix:
Gender:F
Credentials:MSN FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621
Mailing Address - Country:US
Mailing Address - Phone:303-857-2711
Mailing Address - Fax:303-857-1408
Practice Address - Street 1:327 PARK AVE
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1929
Practice Address - Country:US
Practice Address - Phone:303-857-2711
Practice Address - Fax:303-857-1408
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO012773590Medicaid
MW0299277OtherDEA
MW0299277OtherDEA
COC422038Medicare PIN