Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7148 | NE |
N | 1223D0001X | Dental Public Health | 7148 | NE |
NPI | 1346653821 |
---|---|
Provider Name | Dr. Katherine Colvin |
First Address | Lincoln, NE 68505 |
Second Address | Lincoln, NE 68588-0618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 03/06/2014 |