Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist | COZ0501949 | CO |
NPI | 1356741052 |
---|---|
Provider Name | Collene Fulton |
First Address | Lafayette, CO 80026-3812 |
Second Address | Lafayette, CO 80026-3812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2014 |
Last Update Date | 29/08/2014 |