Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 0000106 | CO |
NPI | 1083086532 |
---|---|
Provider Name | Karrina Wallace |
First Address | Denver, CO 80203-4264 |
Second Address | Denver, CO 80203-4264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2015 |
Last Update Date | 23/10/2015 |