Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH000906352 | CO |
NPI | 1023659315 |
---|---|
Provider Name | Chelcie Gjellum |
First Address | Parker, CO 80134-9577 |
Second Address | Lone Tree, CO 80124-8454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2019 |
Last Update Date | 08/10/2019 |