Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APN.0993223-NP | CO |
NPI | 1023534245 |
---|---|
Provider Name | Dongsun Shin |
First Address | Parker, CO 80138-8881 |
Second Address | Parker, CO 80138-8881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2017 |
Last Update Date | 18/08/2017 |