Provider Demographics
NPI:1447475686
Name:VIARENGO, ELISSA DIANE (LAC)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:DIANE
Last Name:VIARENGO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:VIARENGO
Other - Last Name:BLESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST STE D204
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1888
Mailing Address - Country:US
Mailing Address - Phone:970-484-8602
Mailing Address - Fax:970-495-0139
Practice Address - Street 1:2001 S SHIELDS ST STE D204
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1888
Practice Address - Country:US
Practice Address - Phone:970-484-8602
Practice Address - Fax:970-495-0139
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO305171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist