Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | DR000000038105 | CO |
NPI | 1578644282 |
---|---|
Provider Name | Dr. Betty Jean Manaster |
First Address | Boulder, CO 80305-5258 |
Second Address | Denver, CO 80262-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |