Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | KS7061 | KS |
NPI | 1073593992 |
---|---|
Provider Name | Dr. Shelly L. Mccolm |
First Address | Lawrence, KS 66049-4835 |
Second Address | Lawrence, KS 66044-2602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
KS7061 | 7061 (01) | KS |