Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 12335 | CO |
NPI | 1003859893 |
---|---|
Provider Name | Carole Traylor |
First Address | Colorado Springs, CO 80923 |
Second Address | Colorado Springs, CO 80923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 29/08/2008 |