Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH.002025741 | CO |
NPI | 1063007987 |
---|---|
Provider Name | Mitchyl Ellen Hedman |
First Address | Colorado Springs, CO 80910-7135 |
Second Address | Colorado Springs, CO 80910-3127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2021 |
Last Update Date | 03/03/2021 |