Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 121564 | CO |
NPI | 1023330297 |
---|---|
Provider Name | Kelly Chasin |
First Address | Winter Park, CO 80482-0003 |
Second Address | Wheat Ridge, CO 80033-6039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2010 |
Last Update Date | 15/02/2010 |