Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 26686 | CO |
NPI | 1013991603 |
---|---|
Provider Name | Marilyn Newsom |
First Address | Boulder, CO 80304-3573 |
Second Address | Boulder, CO 80304-3573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D24833 | (02) |