Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 74 | CO |
NPI | 1114104106 |
---|---|
Provider Name | Carole Nighswander |
First Address | Durango, CO 81301-5498 |
Second Address | Durango, CO 81301-5498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 22/01/2008 |