Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 31931 | CO |
NPI | 1164484739 |
---|---|
Provider Name | Dr. Mary Virginia Macentee |
First Address | Denver, CO 80231-3433 |
Second Address | Denver, CO 80218-1216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 08/07/2007 |