Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 48921 | CO |
NPI | 1093977936 |
---|---|
Provider Name | Crystal B.w. Evig |
First Address | Colorado Springs, CO 80303-1604 |
Second Address | Colorado Springs, CO 80920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 01/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
52259277 | (05) | CO |