Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1386243459 |
---|---|
Provider Name | Jordan Prindle |
First Address | Fort Collins, CO 80525-9768 |
Second Address | Fort Collins, CO 80525-9768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2020 |
Last Update Date | 20/10/2020 |