Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 206662 | CO |
NPI | 1023534195 |
---|---|
Provider Name | Kellie Hammer |
First Address | Littleton, CO 80128-6140 |
Second Address | Littleton, CO 80120-4508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2017 |
Last Update Date | 20/08/2017 |