Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH000200326 | CO |
NPI | 1073927547 |
---|---|
Provider Name | Catherine Reynolds |
First Address | Longmont, CO 80501-7925 |
Second Address | Longmont, CO 80501-7925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 12/06/2014 |