Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 0991661 | CO |
NPI | 1033506936 |
---|---|
Provider Name | Cassandra Stark |
First Address | Denver, CO 80218-3907 |
Second Address | Denver, CO 80218-3907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 20/04/2015 |