Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3220 | CO |
N | 111NN1001X | Nutrition | 3220 | CO |
NPI | 1023450178 |
---|---|
Provider Name | Dr. Susan D Rivard |
First Address | Colorado Springs, CO 80907-7604 |
Second Address | Colorado Springs, CO 80919-1984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2013 |
Last Update Date | 17/07/2013 |