Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 12719 | CO |
NPI | 1013134436 |
---|---|
Provider Name | Judy W Christensen |
First Address | Aurora, CO 80014-1618 |
Second Address | Aurora, CO 80014-1618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009297 | KAISER-COMMERCIAL NUMBER (01) |