Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DEN8957 | CO |
Y | 213EG0000X | General Practice | DEN8957 | CO |
NPI | 1003038472 |
---|---|
Provider Name | Mandy M Newcomer |
First Address | Edwards, CO 81632-2690 |
Second Address | Edwards, CO 81632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |