Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | APN.0995233-CNM | CO |
N | 363L00000X | Nurse Practitioner | APN.0995233-CNM | CO |
NPI | 1154966174 |
---|---|
Provider Name | Jessica Dacic |
First Address | Longmont, CO 80501-3128 |
Second Address | Longmont, CO 80501-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 06/01/2020 |