Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1205439429 |
---|---|
Provider Name | Jaymie Reichman |
First Address | Wheat Ridge, CO 80033-6715 |
Second Address | Wheat Ridge, CO 80033-6715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2020 |
Last Update Date | 19/11/2020 |