Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 002024281 | CO |
NPI | 1003345174 |
---|---|
Provider Name | Kassie Lynette Jane Taylor |
First Address | Colorado Springs, CO 80906-8614 |
Second Address | Colorado Springs, CO 80906-8614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2017 |
Last Update Date | 12/06/2017 |