Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | PA.0006707 | CO |
NPI | 1689207029 |
---|---|
Provider Name | Karlie Straight |
First Address | Berlin, MD 21811-2044 |
Second Address | Fort Collins, CO 80524-4044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2020 |
Last Update Date | 10/05/2021 |