Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | DR.0065965 | CO |
N | 207R00000X | Internist | 665475 | TX |
N | 111NI0900X | Internist | 665475 | TX |
NPI | 1033646252 |
---|---|
Provider Name | Hannah Pederson |
First Address | Niwot, CO 80544-5004 |
Second Address | Niwot, CO 80544-5004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2017 |
Last Update Date | 07/05/2021 |