Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3244 | CO |
NPI | 1568414159 |
---|---|
Provider Name | Dr. Darwin Lee Stjernholm |
First Address | Parker, CO 80134-9073 |
Second Address | Parker, CO 80134-9073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 02/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K102-3 | (02) | CO |