Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 6183 | CO |
NPI | 1114226560 |
---|---|
Provider Name | Dr. Kim Evans Bruno |
First Address | Fort Collins, CO 80524-3218 |
Second Address | Loveland, CO 80538-4982 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2011 |
Last Update Date | 24/03/2011 |