Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 23773 | CO |
NPI | 1134127434 |
---|---|
Provider Name | Donna Lee Mcfadden |
First Address | Grand Junction, CO 81502-0062 |
Second Address | Grand Junction, CO 81501-6132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01237734 | (05) | CO |
D24325 | (02) |