Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant |
NPI | 1437800471 |
---|---|
Provider Name | Carolyn Jensen Jackson |
First Address | Thornton, CO 80233-1545 |
Second Address | Lafayette, CO 80026-3370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2022 |
Last Update Date | 11/01/2022 |