Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 0008037 | CO |
NPI | 1417513060 |
---|---|
Provider Name | Celeste Irene Hendry |
First Address | Gunnison, CO 81230-2103 |
Second Address | Gunnison, CO 81230-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2019 |
Last Update Date | 18/05/2019 |