Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 48269 | CO |
NPI | 1003088840 |
---|---|
Provider Name | Jenny Mild Connery |
First Address | Aspen, CO 81611-1476 |
Second Address | Aspen, CO 81611-1476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2008 |
Last Update Date | 06/12/2011 |