Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MT.0017307 | CO |
NPI | 1588110654 |
---|---|
Provider Name | Julie Justice |
First Address | Aurora, CO 80011-8318 |
Second Address | Aurora, CO 80011-8318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2016 |
Last Update Date | 29/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45-4892450 | (05) | CO |
45-4892540 | (05) | CO |