Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DR0058864 | CO |
NPI | 1003293408 |
---|---|
Provider Name | Makenzie Lewis |
First Address | Lafayette, CO 80026-7093 |
Second Address | Lafayette, CO 80026-7093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2015 |
Last Update Date | 18/05/2021 |