Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 165214 | CO |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 165214 | CO |
NPI | 1750475190 |
---|---|
Provider Name | Kellie K Monahan |
First Address | Littleton, CO 80127-2908 |
Second Address | Denver, CO 80204-4597 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 10/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05520070 | (05) | CO |
808439 | (02) | CO |