Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 4648 | CO |
NPI | 1104983998 |
---|---|
Provider Name | Jennifer G Doyle |
First Address | Boulder, CO 80303-1133 |
Second Address | Boulder, CO 80304-3972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 21/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00107760 | (05) | CO |
Q75402 | (02) | CO |