Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | ||
Y | 124Q00000X | Dental Hygienist | DH.002024951 | CO |
NPI | 1053828350 |
---|---|
Provider Name | Lauren Nunn |
First Address | Denver, CO 80205-3099 |
Second Address | Louisville, CO 80027-1345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2018 |
Last Update Date | 22/04/2019 |