Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 02572 | CO |
Y | 222Z00000X | Podiatrist | 02572 | CO |
N | 224P00000X | Prosthetist | 02572 | CO |
NPI | 1093221384 |
---|---|
Provider Name | Kristen Michelle Thessing |
First Address | Woodland Park, CO 80863-9206 |
Second Address | Woodland Park, CO 80863-3127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2017 |
Last Update Date | 17/10/2018 |