Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301097300 | MI |
N | 111NI0900X | Internist | 4301097300 | MI |
N | 207R00000X | Internist | DR.0059129 | CO |
N | 111NI0900X | Internist | DR.0059129 | CO |
Y | 207RC0000X | Internist - Cardiovascular Disease | DR.0059129 | CO |
N | 207RI0011X | Interventional Cardiology | DR.0059129 | CO |
NPI | 1023320611 |
---|---|
Provider Name | Dr. Lynn Marie Carlyle |
First Address | Longmont, CO 80504-5311 |
Second Address | Longmont, CO 80504-5311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2010 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9000150154 | (05) | CO |