Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CO | |
Y | 222Z00000X | Podiatrist | CO | |
N | 224P00000X | Prosthetist | CO |
NPI | 1265939474 |
---|---|
Provider Name | Heather Willets |
First Address | Broomfield, CO 80020-5476 |
Second Address | Lafayette, CO 80026-3389 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 12/04/2018 |