Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 49140 | CO |
NPI | 1154460186 |
---|---|
Provider Name | Jennifer Fitzpatrick |
First Address | Pueblo, CO 81008-2210 |
Second Address | Pueblo, CO 81008-2210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 12/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06488846 | (05) | CO |