Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 30 | MT |
NPI | 1144551656 |
---|---|
Provider Name | Dr. Johannah Reilly |
First Address | Boulder, CO 80301-1214 |
Second Address | Boulder, CO 80301-1214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2010 |
Last Update Date | 22/01/2010 |