Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0991394 | CO |
NPI | 1013440726 |
---|---|
Provider Name | Andrea Crandall |
First Address | Denver, CO 80238-3542 |
Second Address | Parker, CO 80138-8880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 10/04/2017 |