Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | DR.0064216 | CO |
NPI | 1063048486 |
---|---|
Provider Name | Jennah Mann |
First Address | Aurora, CO 80042-0429 |
Second Address | Boulder, CO 80309-2550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2020 |
Last Update Date | 16/11/2020 |