Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 66089 | CO |
NPI | 1013926609 |
---|---|
Provider Name | Lynne Parker |
First Address | Pueblo, CO 81004-2117 |
Second Address | Pueblo, CO 81004-2006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 10/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
810212 | MEDICARE GROUP NUMBER (01) | CO |
87588820 | MEDICAID GROUP NUMBER (01) | CO |
88229742 | (05) | CO |