Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1053589168 |
---|---|
Provider Name | Lisa D Reese |
First Address | Fort Collins, CO 80521-1923 |
Second Address | Fort Collins, CO 80521-1923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 13/05/2008 |