Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3903 | CO |
NPI | 1285622027 |
---|---|
Provider Name | Donald E Duranso |
First Address | Colorado Springs, CO 80918-4042 |
Second Address | Colorado Springs, CO 80918-4042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 09/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC016391 | (02) | CO |
M36049 | WORK COMP (01) | CO |