Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | APN.0996501-CNM | CO |
NPI | 1063186146 |
---|---|
Provider Name | Mallory Kendal Otto |
First Address | Broomfield, CO 80021-2728 |
Second Address | Denver, CO 80220-3910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2021 |
Last Update Date | 26/10/2021 |