Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | DR.0064015 | CO |
NPI | 1437512811 |
---|---|
Provider Name | Adelaide Violet Packard |
First Address | Castle Rock, CO 80109-8414 |
Second Address | Castle Rock, CO 80109-8414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2016 |
Last Update Date | 23/09/2020 |