Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 210239 |
NPI | 1316519986 |
---|---|
Provider Name | Julie Haagenstad |
First Address | Windsor, CO 80550-3185 |
Second Address | Windsor, CO 80550-3185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2021 |
Last Update Date | 13/07/2021 |