Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DR.0067176 | CO |
NPI | 1003444159 |
---|---|
Provider Name | Heidi Yen Hallam |
First Address | Westminster, CO 80031-3807 |
Second Address | Westminster, CO 80023-9206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2020 |
Last Update Date | 11/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9000183025 | (05) | CO |