Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 168935 | CO |
NPI | 1225227234 |
---|---|
Provider Name | Martina Ann Paiz |
First Address | Lafayette, CO 80026-2832 |
Second Address | Thornton, CO 80229-4537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 19/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6050018 | (05) | CO |