Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 55197 | CO |
NPI | 1013274430 |
---|---|
Provider Name | Kelly Elizabeth Faulk |
First Address | Denver, CO 80238-3057 |
Second Address | Aurora, CO 80045-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 28/06/2019 |