Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0051721 | CO |
Y | 208000000X | Pediatrician | 8131A | WY |
N | 208000000X | Pediatrician | ML20008677 | WA |
N | 2080A0000X | Adolescent Medicine | 8131A | WY |
NPI | 1114037389 |
---|---|
Provider Name | Kathleen Anne Hannifan |
First Address | Fort Collins, CO 80524-4007 |
Second Address | Fort Collins, CO 80524-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 16/07/2014 |