Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH.002023896 | CO |
NPI | 1023778321 |
---|---|
Provider Name | Laurie Owen |
First Address | Durango, CO 81302-1328 |
Second Address | Cortez, CO 81321-3562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2021 |
Last Update Date | 28/12/2021 |