Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 28068 | CO |
Y | 111NI0900X | Internist | 28068 | CO |
NPI | 1003029299 |
---|---|
Provider Name | Katrina Wagoner-Hursh |
First Address | Denver, CO 80218-1126 |
Second Address | Denver, CO 80218-1126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 11/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006098 | KAISER COMMERCIAL NUMBER (01) | CO |
01280684 | (05) | CO |
F01479 | (02) |