Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 000905893 | CO |
NPI | 1083024541 |
---|---|
Provider Name | Laura Peterson |
First Address | Fort Collins, CO 80526-2881 |
Second Address | Fort Collins, CO 80526-2881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2014 |
Last Update Date | 05/05/2014 |