Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00044545 | WA |
N | 207VX0000X | Obstetrician | MD00044545 | WA |
NPI | 1255494613 |
---|---|
Provider Name | Kelley K Glancey |
First Address | Winter Park, CO 80482-1312 |
Second Address | Winter Park, CO 80482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 31/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0203552 | LABOR AND INDUSTRIES (01) | WA |
8430563 | (05) | WA |
I31953 | (02) |